Wednesday, 31 January 2018

Incidence of Adenoid Hypertrophy in HIV Infected Individuals at a Tertiary Care Hospital


Adenoid is the condensation of lymphoid tissue at the posterosuperior wall of nasopharynx. Adenoids are part of waldeyer’s ring. It is considered to have a crucial role in immunological memory of child. There are reported and documented evidences of adenoid hypertrophy in Human Immune Deficiency Syndrome (HIV) infected individuals but there lacks a large study of such cases. The idea of the present study is to observe the status of adenoid hypertrophy in HIV infected individuals.

The study was conducted in the department of otolaryngology of a tertiary health care hospital. Patients were selected randomly from the register of ART centre of hospital that was undergoing treatment. 100 patients were selected who gave consent for inclusion into the study. A thorough otolaryngology examination was carried out which also included anterior rhinoscopy. All patients were then subjected to diagnostic nasal endoscopy. Adenoid status was recorded and lateral view X- ray of neck soft tissue was done to confirm adenoid hypertrophy.

 The mean age of patients was 37.6 years. Most of the patients (61%) were in age group of 31-45 years. Most of the patients (47 %) have third degree of adenoid hypertrophy. 42% patients have insignificant (1st and 2nd degree) adenoid hypertrophy and 58% had significant (3rd and 4th degree).  

The adenoid is the condensation of lymphoid tissue at the posterosuperior wall of nasopharynx. Adenoids are part of waldeyer’s ring. They are considered to play a crucial role in immunological memory of childhood infections. Adenoids are usually present in children between age 6- 10 years and usually regresses by 16 years. Adenoids are usually not seen in adults and if seen are misdiagnosed and wrongly treated. Adenoid hypertrophy (AH) in adults may be due to immunocompromised status such as or gan transplant recipient, malignant lymphomas and acquired immune deficiency syndrome (AIDS). Enlarged adenoids can achieve the size of a ping-pong ball and completely block the nasal passage. Further blockade may lead to recurrent sinusitis, rhinitis and acute otitis media.

Tuesday, 30 January 2018

The Association of Epicardial Fat Thickness to Cardiovascular Clinical Outcomes

Epicardial fat is a visceral fat deposit which is located between the heart and the pericardium sharing many of the patho-physiological properties of other visceral fat deposits. There is recognition of three functional types of adipose tissue. The first type, the white adipose tissue consists of large unilocular adipocytes whose primary function is to store energy in the form of triglyceride. The second type, the brown adipose tissue which contains multilocular adipocytes with large numbers of mitochondria, this is most commonly found in young mammals and rodents. Its primary function is to generate heat via uncoupled oxidative phosphorylation. Third, the beige adipose tissue is form of brown adipocytes that arises within the white adipose depots and also has thermogenic capacity. 

It is important to differentiate between the adipose tissue located on the outer surface of the fibrous pericardium (paracardial fat) from the one in the inner surface of the visceral pericardium (epicardial fat) which is in direct contact with the myocardium and the epicardial vessels, since they differ in their biochemical, molecular and vascular nutrition properties. The paracardial fat is nourished by the pericardiophrenic artery, a branch of the internal thoracic artery, while the epicardial fat is nourished by the coronary arteries. The epicardial fat is more prominent in the atrioventricular and interventricular grooves and right ventricular lateral wall. Adipocyte infiltration into the myocardium wall as well as triglyceride infiltration into myocytes may also occur. The paracardial fat has been also called intrathoracic, mediastinal or pericardial. In addition, some other groups treat these different fat deposits as a single compartment, calling it pericardial fat. Since several studies have observed a moderate association between EFT and cardiovascular clinical outcomes, it is important to analyze this relationship at the light of medicine based evidence.

Epicardial fat thickness (EFT) can be measured by different imaging modalities. Magnetic resonance imaging (MRI) is considered the gold standard for the assessment of total body fat and reference modality for the analysis of ventricular volumes and mass, thus making it a natural choice for the detection and quantification of EFT. For purposes of cardiovascular risk stratification, measurement of EFT using echocardiography has generally been the study of choice, due to its lesser cost, ease of use, and absence of radiation. By echocardiography, measurements of the right ventricular free wall from both parasternal longitudinal and transverse parasternal views should be performed using the mean of three consecutive beats. These echocardiographic measurements show good correlation with the values found on MRI (r = 0.91, p = 0.001). There are some controversial issues in the EFT measurements by echocardiography. For example, there are some inconsistencies in the site of measurement due to spatial variations of the echocardiographic window, especially along the great vessels and the right ventricle. In addition, it is uncertain yet which moment of the cardiac cycle is the most suitable for measuring EFT by echocardiography. Some recommend the measurement during systole to prevent possible deformation by compression of the epicardial fat during diastole. On the other hand, other researchers prefer measurements in diastole to coincide with measurements of other imaging modalities like CT scans and MRI. 

Monday, 29 January 2018

How to Take Action Against Acne


Sitting tight for skin inflammation to clear up without anyone else can be disappointing, particularly for teenagers who are as of now reluctant about their appearance. Untreated skin break out can cause low confidence and uneasiness and additionally lasting facial scars. Disregarding it or expecting children will exceed it can hurt them physically and inwardly. Skin inflammation can likewise proceed into the grown-up years, and be particularly risky for ladies. Mellow cases with only a couple of flaws or clogged pores may react in a month or two to over-the-counter drugstore items with fixings, for example, benzoyl peroxide or salicylic corrosive. These are intended to unblock pores and empower cell turnover. 

However, profound pimples and kindled pustules require the quality of remedy items and the know-how of a dermatologist. Most solutions are topical. That implies they're connected to the skin, commonly to eliminate microscopic organisms as well as decrease oil. Regularly in gel shape, they may contain a retinoid (a vitamin A-based fixing), solution quality benzoyl peroxide, or anti-infection agents. There are numerous successful blends that your dermatologist can suggest. On the off chance that one doesn't work, another might. 

Serious skin break out, with pimples and knobs, regularly needs medicine in pill shape, from anti-infection agents to the most effective vitamin A medication called isotretinoin. As indicated by the American Academy of Dermatology, one 4-or 5-month course of isotretinoin achieves clear skin in 85 percent of patients. In any case, it can have genuine symptoms, fundamentally birth abandons, so it's basic that individuals taking it don't wind up noticeably pregnant (or even bosom bolster) while on it. There are likewise numerous office systems that may help, for example, lasers and other light treatments; compound peels; and extractions, which expel obstinate blisters and help forestall scarring. With such a significant number of choices, there's no motivation to endure this skin condition.

Thursday, 25 January 2018

Christmas 2016: Needs and the Realities


In this issue, I would like to mention about the main problems, needs and realities for healthcare professionals and especially for surgeons. Surgical residency is a difficult period for physicians and there are lots of problems during this period. Education and practice are the most important parts of surgical residency. When a physician starts the residency period, he/ she wants to be the most capable and active doctor of their branches. Enthusiasm lead physicians for working hard during this period butthey alsoface different type of problems. Several studies were reported in the literature that were indicating the main difficulties of education and social problems. Also lack of standardisation for education is the main problem in most of the European countries and this problem causes lack of confidence at the end of this education period. Surgical residency needs this standardisation so that surgeons would be more confident and capable after they become specialists. After this education period, unfortunately the problems do not end. 

Doctors that have become specialists face different type of problem seven they are academic or non-academic. In almost all European countries, lack of academic positions make doctor loose their enthusiasm and interest in academic activities. For non-academics, it is nearly the same. When they start to work in any place of their countries, they face different type of problems. They cannot find enough devices or instruments to show their experience they have gained during their residency period. They do not get enough salaries for satisfaction. In some countries, patients have prejudice for doctors and they do not get satisfied with the health service in hospitals. 

After a time period, snowflakes are growing bigger and doctors are getting unhappy and reluctant. In most of the countries, Ministries of Health do not take enough care of doctors and healthcare professionals. Bigger and comprehensive studies must be conducted in order to reveal the problems of these healthcare professionals so they will be happier and more successful doctors even they are residents or specialists. I wish happier academicians, happier doctors and as a result happier patients within next year for all countries. Get up, stand up and do not give up the fight! 

Wednesday, 24 January 2018

Ibuprofen Overdose Requiring Vasopressor Support in a Pediatric Patient


Here we present the case of a 14-year-old female who presented to our community emergency department after reportedly ingesting about 30 tablets of an unknown medication while at school about 2 hours prior to arrival. She denies suicidal ideation, gestures, plan or attempt (although she admitted a history of suicide attempts); stating she took it for relief of knee pain. The medication was her friend’s. She reported malaise, nausea, dry mouth, blurry vision, jitteriness, and dyspnea; denying any other systemic complaints, including vomiting of pill fragment, chest or abdominal pain, diarrhea, headaches, syncope, light-headedness, or diaphoresis. She had no medical or surgical history, and denied drug or food allergies. She took no medications on a daily basis, and all immunizations were up-to-date. The patient admitted to smoking marijuana once within the past month; no other illicit drug intake, as well as no alcohol or tobacco products.

Given her significant presentation, she was dispositioned as ESI level 1 (emergency severity index, on a scale from 1 to 5, with a lower number representing higher acuity). Initial vital signs were as follows: blood pressure 105/54 mmHg, pulse rate of 130 beats per minute and regular, respirations of 14 breath per minute, saturating 100% on ambient air, and axillary temperature of 98.8 Fahrenheit. On examination, she was somnolent but arousable to loud verbal as well as noxious stimuli; Glasgow Coma Scale 14. On physical examination, she appeared toxic and uncomfortable. Neurologic exam including speech and mentation were intact, aside from her eyes which were 3 mm bilaterally, not reactive to light and exhibited roving movement. Cardiopulmonary exam was insignificant aside from the tachycardia as noted. Skin was not diaphoretic, of normal colour and without piloerection. She weighed 52 kg (BMI: 19). A work-up was immediately undertaken focusing on suspected overdose, inflammatory and cardiac markers. Lactate was 3.7 mmol/L (reference range: <2.2). Arterial pH 7.34. Remaining bloodwork, including electrolytes, blood counts, liver/kidney/ pancreas functions, cardiac biomarkers, coagulation studies, osmolality, urinalysis, urine drug screen, alcohol, and salicylate levels were unremarkable. Her urine pregnancy was negative.

 A portable plain chest film was without an acute process. An electrocardiogram done upon initial presentation and repeated about 3 hours later both revealed sinus tachycardia in the 120-130 beats per minute, with normal axis and intervals (QRS 84 and 110 milliseconds, QTc 457 and 489 milliseconds, respectively), without an acute current of injury. Intravenous fluids in the form of normal saline were ordered as well as lorazepam for agitation. Naloxone was also attempted for somnolence without a response. Despite a weight-based dose for fluid resuscitation, her blood pressure was 84/57 mmHg; she remained tachycardic in the 120s, vital signs otherwise were stable. A central line was placed and Dopamine initiated. Anticholinergic overdose was briefly entertained, although her clinical presentation did not completely align with the familiar toxidrome. More information was soon available when the patient’s parents arrived: the mother strongly suspected she took Motrin from one of her friends, estimated to be about 18 grams (30 tablets, 600 mg each). It was also discovered she was taking oral contraceptives, valacyclovir, and was on a course of ciprofloxacin for cystitis. Pantoprazole was added intravenously.

Tuesday, 23 January 2018

Opioid Epidemic Also Taking Toll on Babies


In yet another case of how broad the aftermath from America's opioid scourge is, analysts report that children presented to these opiates while in the womb risk certain head and neck anomalies. One is a turning of the neck (torticollis) and the other is a smoothing of the head (plagiocephaly), which frequently happens couple with torticollis. In the examination, specialists at Cincinnati Children's Hospital Medical Center took a gander at 783 babies conceived more than five years, and found that 87 (11 percent) of those presented to opioids in the womb were determined to have torticollis. 

In 1994, the rate of torticollis in the all inclusive community was 0.3 percent to 1.9 percent, the examination creators noted. "Familiarity with these potential issues in this populace is fundamental, as torticollis may not create for a while after the newborn child has been released from the healing center," said examine creator Dr. Jenny McAllister. Neonatal forbearance disorder (NAS) is activated by withdrawal after introduction to opioids in the womb. The frequency of NAS climbed very nearly fivefold in the vicinity of 2000 and 2012. "In the event that preventive measures are performed -, for example, word related and active recuperation - torticollis and plagiocephaly might be maintained a strategic distance from and possibly anticipate formative deferrals," McAllister included. 

It's not known whether opioid introduction in the womb really causes torticollis. These newborn children could have a snugness of their muscles (hypertonia) that inclines them to torticollis, or the condition could be the aftereffect of swaddling that is done to keep them quiet after birth, McAllister clarified. Of the newborn children in the examination, very nearly 76 percent were presented to short-acting opioids, while a little more than 72 percent were presented to numerous opioids. Newborn children in withdrawal were for the most part treated with methadone, yet 18 percent were treated with buprenorphine and near 6 percent with morphine. Their opportunity in the doctor's facility arrived at the midpoint of around 19 days.

Monday, 22 January 2018

The Psychology of Justice: The Interface Between Psychology & Civil Law

Since the 1970’s, psychologists and psychiatrists have developed their expertise in providing expert witness services in civil claims for personal injury and medical negligence. By doing this, they have helped lawyers and the courts understand more about diagnosis, causation and prognosis. However, the relevance of psychology and psychological medicine has a much wider applicability to the civil justice system. In Tort Law, the focus is on Justice as the goal, ensuring a more fair, equitable, holistic and reliable outcome to a personal injury event. This is in addition to the quantum assessment of damages and attempts to conduct the process efficiently. 

Understanding and measuring ‘justice’ is a challenge due to its complex multi-dimensional nature. Both claimants and defendants of claims need to be assured that medico-legal process goals are balanced fairly with justice goals, making civil claims more ‘just’ and ‘better’, not just faster and cheaper. Increasing attention is now being centred on how psychological and social processes affect civil justice and the way it is carried out in the UK and other countries, both in Europe and North America. Starting at the point of a personal injury event such as a road traffic accident or work accident through to the conclusion of litigation, there are many psycho-social processes involving claimants, lawyers, medical experts, barristers and the judiciary which can affect any one particular case and assessment of damages. The main branches of psychology which are applicable to the medico legal trail.

It is important that both academic and practitioner groups are active in promoting the understanding of the interface between Law (and legal systems) and Psychology in the context of civil cases and litigation, and thereafter to provide education to legal students and practitioners on these issues. This collaboration should inform the scientific, medical and psychological communities on the one hand, and legal communities on the other, and also the public, about current research and practice in the area of science and law. Civil courts admit evidence from health care experts in order to assess injury and determine quantum. It points to a need for Law and Psychology to address the use of science, and both sectors’ narrow constructions of rationality and logicality which can often have the effect of divorcing science and ‘facts’ from their psychological and social context. 

Friday, 19 January 2018

MEG Evaluation of the Function of Alpha and Beta Rhythms After Visual Stimulation

Magnetoencephalography (MEG) is a functional neuroimaging technique for mapping brain activity by recording magnetic fields produced by electrical brain currents, using very sensitive magnetometers and it gives improved spatial resolution with particularly high temporal resolution. Since the MEG signal is a direct measure of neuronal activity, its temporal resolution is comparable with that of intracranial electrodes. MEG complements other brain activity measurement techniques such as electroencephalography (EEG), positron emission tomography (PET), and functional magnetic resonance imaging (FMRI). It is a non-invasive method and uses no ionizing radiation, as opposed to PET. MEG can resolve events with a precision of greater than ten milliseconds (msec), while fMRI, can at best resolve events with a precision of several hundred milliseconds (msec). MEG is also being used to better localize responses in the brain.  

The responses in the brain before, during, and after the introduction of stimuli can be mapped with greater spatial resolution than was formerly potential used with EEG. The pineal gland controls the hormone system and at night it is releasing one important hormone the melatonin in the blood stream and from the blood stream to the brain. Sandyk reported a case of a patient with multiple sclerosis in whom visual perception worsened throughout the course of the day and improved at night. These changes in vision appeared to correspond to the circadian secretion of melatonin which is coupled to the circadian temperature rhythms. Ter Huurne et al investigated whether aberrant modulation of alpha oscillations contributes to attention problems in Attentiondeficit/hyperactivity disorder (ADHD) patients with the use of MEG. 

They suggested that aberrant modulations of alpha oscillations reflect attention problems because of ADHD and might be related to the neurophysiological substrate of the disorder. Babiloni et al investigated if simple delayed response tasks affect latency and amplitude of MEG midline alpha rhythms (6-12 Hz) in early dementia. They found that the alpha peak was later in latency in the demented and normal elderly subjects than in the normal young subjects and it was stronger in amplitude in the demented patients than in the normal subjects. Anninos et al in a MEG study discussed the potential essential role of the pineal gland in the long term anticonvulsant effects of external artificial magnetic stimulation because the pineal gland has been shown to be a magnetosensitive organ which forms part of a combined compasssolar clock system and exerts an inhibitory action on seizure activity. Sandyk et al based on MEG measurements suggested that patients with nocturnal epilepsy or those experiencing exacerbation of seizures premenstrually may benefit from the administration of agents which block the secretion or action of melatonin.