International Journal of Research in Medical Sciences
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Published By Medip Academy

2320-6012, 2320-6071
Updated Friday, 17 September 2021

Author(s):  
Zhang Yingli

Background: Diabetic foot is one of the main reasons that seriously affect the quality of life and disability. Good foot care can prevent 85% amputation of diabetic foot patients. The purpose of this study is to explore the effects of interactive education with conversation map on foot care behaviors among elderly diabetic patients with high-risk diabetic foot.Methods: 96 elderly diabetic patients in Endocrinology Department of the Second Affiliated Hospital of Shandong First Medical University from January to December in 2020 were selected as the research objects. According to the parity of the last two digits of the hospitalization number, the odd number was divided into the control group and the even number was divided into the experimental group. The control group was given traditional health education and interactive education with conversation map for diabetic foot launched by the international diabetes federation was added to the experimental group. After 3 months of intervention, fasting blood glucose, 2 hours postprandial blood glucose, glycosylated hemoglobin and foot care behaviors of the two groups were observed.Results: The fasting blood glucose, 2 hours postprandial blood glucose, glycosylated hemoglobin and foot care behaviors of the experimental group were significantly better than those of the control group and the difference was statistically significant (p<0.05).Conclusions: The interactive education with conversation map can effectively improve the foot care behaviors of elderly diabetic patients with high-risk diabetic foot, and then prevent the occurrence of diabetic foot.


Author(s):  
Ken Christian Kawilarang ◽  
I. Kadek H. Hermawan ◽  
Febryanti Hartono

TAVB is common complication of acute inferior myocardial infarction (AMI). Total atrioventricular block (TAVB) occurs when none of the impulses are conducted from atrium to ventricles and move independently without coordination. In our case, A 61-year-old woman came to the emergency room (ER) with chief complaint of general weakness and nausea without any other complaints since 4 days before going to ER. She had TAVB which is a complication of undiagnosed AMI due to silent ischemia. She didn't get reperfusion therapy because of patient delay and limited resources. Pharmacological therapy had been given while awaiting implantation of temporary pacemaker (TPM). Two days after insertion, the heart rhythm returned to sinus rhythm, therefore permanent pacemaker implantation was not required. TAVB in AMI usually resolves spontaneously. Therefore, it is important to identify TAVB in AMI, so we can quickly diagnose and promptly treat the patient. Thus, it can reduce mortality and increase the probability of spontaneous resolution of TAVB, so physician practice management (PPM) insertion can be avoided.


Author(s):  
Monika Gupta ◽  
Pinki Devi ◽  
Anjali Bishley ◽  
Sant Prakash Kataria ◽  
Rajeev Sen

Acute lymphoblastic leukaemia is the most common hematopoietic malignancy in childhood, comprising of B-cell lineage (85%) and T-cell lineage (15%). Recent studies have identified a subtype of T-cell acute lymphoblastic leukaemia (T-ALL) termed “early T-cell precursors (ETP)” recognised as a new provisional entity in 2016 update to the World Health Organization (WHO) classification of acute leukaemia, early T-cell precursor acute lymphoblastic leukemia (ETP-ALL) is characterized by a unique immunophenotype and genetic profile and its origin has been found to be from migration of cells from thymus to bone marrow. Hence, our study aims at reporting the prevalence of ETP-ALL among immunophenotypically categorised acute T-cell lymphoblastic leukaemia cases. Present work is a retrospective observation of acute T-cell lymphoblastic leukemias and reporting ETP-ALL cases seen during the period of over two years (from August 2018 to August 2020) received for flowcytometry in the department of Pathology, PGIMS, Rohtak, Haryana. Peripheral blood showed features of acute leukemia and immunophenotyping was performed. Fourteen cases were received for flowcytometry showing features of acute leukemia and immunophenotyping was performed revealing two ETP-ALL cases with positivity for cytCD3, CD7 (T-cell markers), HLA-DR, CD13 (myeloid marker-aberrant expression), sCD34, CD117 (stem cell markers), CD19 (B-cell marker) and dim expression of CD45. This study is a supportive data for immunophenotypic identification of ETP-ALL cases in centres where genetic study and other ancillary techniques are not available. It needs to be differentiated from non ETP-ALLs as this entity has been reported to show treatment failure with the treatment modalities for non ETP-ALLs.


Author(s):  
Luh Putu Venny Cempaka Sari

Topical sunscreen is a potential modality to prevent skin cancer development in vulnerable people although few study has evaluated its effectiveness in clinical setting. This study is aimed to review most recently available evidence on the clinical effectiveness of topical sunscreen in preventing skin cancers. We identified literature from online databases including Pubmed and Google Scholar and included population-based study evaluating the effect of sunscreen usage and risk of skin cancers, including melanoma, squamous cell carcinoma (SCC), and basal cell carcinoma (BCC) either as primary objective or as a confounder in multivariate analysis. Data form included articles was harvested and analyzed with thematic analysis. Final analysis included 11 articles. Of these, 6 reported results on melanoma, 4 reported on BCC, and 3 on SCC. Overall, there was conflicting evidence on the effectiveness of topical sunscreen in preventing skin cancer. Available evidence found that topical sunscreen was most effective in preventing melanoma and SCC. However, there was considerable heterogenicity in study design and definition of sunscreen treatment between included articles that may affect the results. There are no consensus among included articles, including among RCTs, on the ideal topical sunscreen regiment to prevent skin cancer. There are conflicting evidence on the clinical effectiveness of topical sunscreen to prevent skin cancer although evidence suggest that it would be effective in preventing melanoma and SCC. More clinical studies should be conducted with special emphasis on ensuring subject apply the sunscreen correctly and consistently.


Author(s):  
Rajesh K. Kushwaha ◽  
Rajiv Ranjan ◽  
Makardhawaj Prasad

Background: Nutrient foramen gives passage to the nutrient vessels which supply major portion of the bone even bone marrow. Many vascular foramina are present in all bones for the passage of blood vessels. In long bones many small vascular foramina are present at the ends through which epiphyseal and metaphyseal blood vessels passes. In the shaft of long bones one or two larger foramina are present through which nutrient vessels passes. Nutrient artery provides 70% to 80% blood supply of long bones in children and if blood supply is decreased, it may lead to ischemia of bone resulting into less vascularisation of metaphysis and growth plate. Thus precise topographical knowledge of nutrient foramen is necessary for the surgeons to save the nutrient vessels during surgical procedures i.e. fracture fixation, bone grafting etc. Damage to the nutrient artery causes avascular necrosis of bone.Methods: Total 70 dry bones of tibia were taken in the study, without knowledge of sex of the bone. Position, number and direction of the nutrient foramen were noted.Results: single nutrient foramina present in 91.43% of cases and double in 6% of cases. 97.14 % nutrient foramina are directed downward and 2.86% directed upward. 90% nutrient foramina present on posterior surface, 1.42% on lateral surface and 8.57% on lateral border. 75% of nutrient foramina present in upper 1/3 and 25% in middle 1/3. Primary nutrient foramina (>24 G) present in 89.47% and secondary nutrient foramina (<24 G) present in 10.53% of cases.Conclusions: A sound knowledge of nutrient foramen topography, prevent the injuries of vasculature of bone during surgeries.


Author(s):  
Rajendra K. Ghritlaharey

This is a review of the literature related to the progress in the management of intussusception. Literature and other publication on the topic of “intussusception” were retrieved from 1674 to August 2021. The online literature search was – performed using various websites, i e, PubMed, PubMed central, ResearchGate, and Google - eBooks, Google Scholar, and Google Images. The important historical events that occurred in the management of intussusception were briefly presented in this manuscript.


Author(s):  
Nutan Bedi ◽  
Archana Omprakash Gulati ◽  
Gauri V. Devasthali

Background: Diabetes is a disease, which if not controlled, affects every cell of the body from head to toe. No wonder it is often referred to as the “SILENT KILLER”. So through our study, we aim to study the correlation between (haemoglobin A1c) HbA1c levels, duration of diabetes and modifiable risk factors with diabetic retinopathy (DR) in patients of type 2 diabetes mellitus.Methods: This study was conducted in 100 patients (200 eyes) who were diagnosed cases of type 2 diabetes mellitus. A detailed history of the duration of diabetes, alcohol intake and smoking and HbA1c levels was taken. Complete ocular examination was done. BMI was also calculated.Results: 2/3rd of the eyes with grade 3 DR were of>10 years duration while 2/3rd of the eyes with grade 2 DR were of 5-10 years duration. Of the eyes with grade 3 DR, all the patients had HbA1c of more than 8. Significant p value shows strong correlation between DR and obesity. No significant correlation of DR was found with alcohol and smoking.Conclusions: The findings in our study endorse the view that duration and HbA1c are important risk factors for occurrence and severity of DR and therefore a regular follow up and good glycemic control is highly essential for the prevention of occurrence and progression of DR. Strong correlation between BMI and DR suggest that lifestyle changes play a pivotal role.


Author(s):  
Pradeep Gupta ◽  
Vikram Singh Mujalde

Background: Congenital esophageal atresia with tracheo-esophageal fistula is a common congenital anomaly facing at our centre. There is various proposed anastomotic technique to avoid post-operative complications. In our center, feeding has been conventionally initiated after a contrast esophagogram done at the seventh day post repair. The current study tried to assess the benefits and risks of initiation of early feeding in these patients by placement of a Tran’s anastomotic feeding tube during the repair.Methods: Twenty-five patients had a trans anastomotic feeding tube inserted during trachea esophageal fistula repair and were followed up for different outcomes.Results: Twenty-five patients were operated out of which were sixteen males and nine were females. Early complications of esophageal atresia surgery such as anastomotic leak, surgical site infection, pneumonia and sepsis occur in eight patients. All the complications were managed successfully conservatively, however, one patient died due to anastomotic leak and subsequent septicemia.Conclusions: We conclude that early tube feeding is safe and does not increase risks of anastomotic leaks. It also reduces the need of total parenteral nutrition bringing down the costs of procedure in developing nations.   


Author(s):  
Mohammad Nazrul Hossain ◽  
Mohammad HUmayun Rashid ◽  
Israt Zerin Eva ◽  
M. Sharif Bhuiyan ◽  
Abdullah Al Mamun

Background: Chronic subdural hematoma (CSDH) is an increasingly common neurological disease in daily neurosurgical practice. Despite the wide prevalence of CSDH, there remains a lack of consensus regarding numerous aspects of its surgical management. The diagnosis and treatment are well established but there are different surgical procedures and outcome related to these procedures are not completely understood.Methods: The study conducted was conducted in department of neurosurgery at Ibrahim cardiac hospital and research institute, Dhaka, Bangladesh between January 2019 to July 2020, 105 patients were treated for chronic subdural haematoma This study evaluated the clinical features, radiological findings and surgical outcome by mini craniotomy assessed by modified Rankin scale (mRS) score and Glasgow outcome scale (GOS) score in a large series of patients treated at single institution.Results: At 6 months follow up, only one patient died (0.95%) because of co-morbidities and not directly related to the chronic subdural haematoma, 15 patients (14.3%) improved to mRS 0, 33.33% showed only mild symptoms without any significant disability-mRS 1, slight disability was observed in 28.5% patients, moderate disability was observed in 17.14% patients-mRS 3, moderately severe disability was observed in 5.7%-mRS 4.Conclusions: GOS score at 6 months follow up which shows majority of the patient improved to GOS score 4 (45.71%) and 5 (38.09%). Based on these results, among various method of surgical management, mini craniotomy provides better outcome.


Author(s):  
Ranjith Chittikappil Gopalan ◽  
Shaji Urambath Abu ◽  
Ljo John Kollannur ◽  
Rony Louis

Background: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality. Decompressive craniectomy (DC) is a common surgery done for patients with TBI. An analysis of factors that determine the outcome and complications will go a long way in improving the prognosis of such patients.Methods: This is a single‑center, retrospective study of TBI patients who underwent DC from March 2016 to February 2020 at a tertiary care hospital in South India. Demographic profile, clinical data, radiological findings, intraoperative observations, postoperative complications, and Glasgow Outcome Score (GOS) at discharge were noted.Results: 164 patients underwent DC. Road Traffic Accident was the most common cause (116 patients) 71%. The mortality rate among patients with a motor score of M1 was 73.8%, 77.8% in the M2 group, 54.4%, 34.6%, and 10.6% in M3, M4, and M5 groups respectively. The survival rate among patients with bilaterally dilated pupils was 18.1%. 48.3% and 62.1% in those with unequal and equal reactive pupils respectively. The most common pathology was subdural hemorrhage in 108 (65.9%). External cerebral herniation was seen in 62 cases (37.8%). The mortality rate was 39% (64 patients). Persistent vegetative state was noted in 6.1% (10 patients) and severe disability in 24.4% (40 patients). Poor outcome was seen in 69.5% (114 patients). Primary DC was done in 113 patients (68.9%) with a mortality rate of 39.8% (45 patients) and secondary DC in 51 patients (31.1%) with a mortality rate of 37.2% (19 patients).Conclusions: Preoperative low motor score and dilated pupils were associated with higher mortality rate. The most common pathologies were subdural hemorrhage (SDH) and contusion and external cerebral herniation was the most common complication. Primary DC had a higher mortality rate than secondary DC.


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