J Clin Diagn Res
· 2017 Sep · PMID 29207787
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Primary fallopian tube carcinoma is an uncommon gynaecologic malignancy usually seen in postmenopausal females. We present a case of a 66-year-old postmenopausal female who presented with complaint of blood mixed vaginal...Primary fallopian tube carcinoma is an uncommon gynaecologic malignancy usually seen in postmenopausal females. We present a case of a 66-year-old postmenopausal female who presented with complaint of blood mixed vaginal discharge on and off for past one month. Workup of the patient revealed no abnormality other than presence of atypical squamous cells on Papanicolaou (PAP) smear. MRI showed mildly bulky cervix with around 4cc fluid in endometrial cavity. As the patient remained symptomatic and fluid in endometrial cavity persisted, total abdominal hysterectomy with bilateral salpingo-oophorectomy was done. On histopathological examination, fimbrial end of left tube had features of poorly differentiated papillary serous adenocarcinoma. Postoperatively, she was given chemotherapy and is doing well with more than 3 years of follow up. This case highlights the importance of high suspicion in postmenopausal women with bleeding per vaginum, where there is little to suggest clinically or radiologically.
J Clin Diagn Res
· 2017 Sep · PMID 29207786
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Vaginal Cuff Dehiscence (VCD) is partial or total separation of anterior and posterior vaginal cuff layers. We report a case of recurrent vault cuff dehiscence in a patient of cervical carcinoma. A 60-year-old treated ca...Vaginal Cuff Dehiscence (VCD) is partial or total separation of anterior and posterior vaginal cuff layers. We report a case of recurrent vault cuff dehiscence in a patient of cervical carcinoma. A 60-year-old treated case of carcinoma cervix post surgery and radiotherapy was found to have vault dehiscence and intestinal prolapse second time during a routine speculum examination. She underwent an emergency laparotomy and closure of vault. Vaginal Cuff Dehiscence with Evisceration (VCDE) is a rare but potentially fatal complication following hysterectomy. Postoperative infection, poor technique, hematoma, coitus before healing, radiotherapy, corticosteroid therapy are the risk factors. Radiotherapy leads to progressive obliterative endarteritis and resultant tissue hypoxia. There is paucity of literature regarding the best management of VCD, but early corrective intervention is necessary. Patients and the treating physicians should be made aware of this possibility especially those receiving adjuvant radiation or cases of robotic or laparoscopic hysterectomies.
J Clin Diagn Res
· 2017 Sep · PMID 29207785
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INTRODUCTION: Characterization of adnexal masses as benign or malignant is of utmost importance for optimal management and prognostication. Ultrasound examination plays an important role in the differentiation of adnexal...INTRODUCTION: Characterization of adnexal masses as benign or malignant is of utmost importance for optimal management and prognostication. Ultrasound examination plays an important role in the differentiation of adnexal masses. Various sonographic characteristics have been recognised to differentiate benign and malignant adnexal masses. Subjective evaluation of gray-scale ultrasound images by an experienced ultrasound examiner to discriminate adnexal masses is known as "pattern recognition". AIM: To access the efficacy of pattern recognition at predicting an accurate histological diagnosis of adnexal masses. MATERIALS AND METHODS: All adnexal masses diagnosed clinically or during screening sonography were included in the study (n=136). Sonographic pattern recognition was performed and documented with specific diagnosis whenever feasible. Risk of Malignancy Index 3 (RMI3) score was also calculated. Results were compared with the gold standard histology. Chi-square test was used to assess the significance of the results and a p-value <0.05 was considered statistically significant. RESULTS: In the final cohort of 136 women, on pattern recognition, 91 were suspected to have benign adnexal masses and 45 were reported as malignant adnexal masses. However, on final histo-pathology, 94 patients had benign tumours and 42 patients had malignant disease. The benign group pattern recognition could render a specific diagnosis in 85.7% as compared to RMI3 pattern recognition conferred a sensitivity of 95.2% (RMI3 78.6%), with a slight compromise in the specificity (94.7% versus 96.8%). CONCLUSION: Pattern recognition is a sensitive and specific sonographic tool in discriminating benign and malignant adnexal masses. Moreover, it is also useful in differentiating various benign adnexal masses.
J Clin Diagn Res
· 2017 Sep · PMID 29207784
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INTRODUCTION: Emergency Peripartum Hysterectomy (EPH), although relatively infrequent in present day obstetrics, is a life-saving procedure in the event of a massive postpartum haemorrhage. AIM: To assess incidence, risk...INTRODUCTION: Emergency Peripartum Hysterectomy (EPH), although relatively infrequent in present day obstetrics, is a life-saving procedure in the event of a massive postpartum haemorrhage. AIM: To assess incidence, risk factors, indications and complications of peripartum hysterectomies at a tertiary care teaching hospital in India. MATERIALS AND METHODS: A retrospective study was conducted at 650-bedded tertiary care medical teaching hospital in Southern India. All emergency peripartum hysterectomies performed between February 2002 and December 2015 at a tertiary care teaching hospital, were included in the study. Demographic characteristics, risk factors, antepartum, intrapartum and post-partum events, need for blood transfusion, length of stay in intensive care unit and postoperative complications were noted. Data was entered in Microsoft Excel spreadsheet and analysed using SPSS software version 22.0. For categorical variables, data was compiled as frequency and percent. For continuous variables, data was calculated as mean±SD. RESULTS: Among 16,473 deliveries in the study period, 12 emergency peripartum hysterectomies were undertaken, the incidence being 0.073%. Women were aged 20 to 40 years (mean 30.25 years). Majority (83%) were multiparous women. Atonic postpartum haemorrhage was the most common (58%) indication for hysterectomy. About 67% of hysterectomies performed were subtotal hysterectomies. One half of them had a previous caesarean section. Two patients had bilateral internal iliac artery embolization for ongoing haemorrhage. All patients required intensive care and blood transfusion. Two patients did not survive even after hysterectomy. CONCLUSION: Atonic postpartum haemorrhage was the most common reason for performing an emergency peripartum hysterectomy. Women with previous caesarean section are at increased risk, both due to atonic and traumatic postpartum haemorrhage. Regular departmental audits are needed to formulate appropriate protocols to decrease mortality and near-miss events like EPH. Stringent protocols should be instituted for managing obstetric haemorrhage. Although EPH is life-saving, early intervention by a senior obstetrician well versed with conservative procedures may avoid morbidity associated with EPH.
J Clin Diagn Res
· 2017 Sep · PMID 29207783
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INTRODUCTION: Oligohydramnios is described as decreased amniotic fluid volume relative to gestational age. Semiquantitatively it is described using the Amniotic Fluid Index (AFI) which is calculated by adding the depth i...INTRODUCTION: Oligohydramnios is described as decreased amniotic fluid volume relative to gestational age. Semiquantitatively it is described using the Amniotic Fluid Index (AFI) which is calculated by adding the depth in centimetres of the largest vertical pocket in each of four equal uterine quadrants. AFI less than or equal to 5 cm is defined as oligohydramnios. A Borderline Oligohydramnios (BO) is defined as AFI 5.1-8 cm. AIM: To assess the maternal and perinatal outcome of induction in borderline oligohydramnios cases at term. MATERIALS AND METHODS: This is a retrospective observational study done from December 2015 to November 2016 in Mahatma Gandhi Medical College and Research Institute, Puducherry, India. Fifty cases of BO with AFI 5.1 cm - 8 cm taken as case and another 50 cases of Normal Liquor (NL) with AFI 8.1 cm - 18 cm taken as control. Data was collected and analysed by SPSS software version 20.0 For qualitative data, the χ-test or Fisher's-exact test were used and for continuous variables, the t-test was used. RESULTS: Cases and controls were matched in baseline parameters. More number of cases were found with meconium stained liquor during labour which is statistically significant (p<0.05). Otherwise there were no statistical significant difference between cases and controls in maternal and perinatal outcome. CONCLUSION: Induction of labour in cases with BO cases compared to those with NL at term did not show very statistically significant difference in terms of induction to delivery interval and neonatal outcome.
J Clin Diagn Res
· 2017 Sep · PMID 29207782
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INTRODUCTION: Preterm delivery remains a challenge in Obstetrics as it is responsible for significant cause of perinatal morbidity and mortality. At present there is no standard test for prediction of preterm labour for...INTRODUCTION: Preterm delivery remains a challenge in Obstetrics as it is responsible for significant cause of perinatal morbidity and mortality. At present there is no standard test for prediction of preterm labour for timely referral to a center with NICU facilities. AIM: To evaluate the effectiveness of the cervical phosphorylated insulin like growth factor binding protein-1(phIGFBP-1), cervical length measurement and combination of phIGFBP-1 with cervical length for Predicting Preterm Labour (PTL). MATERIALS AND METHODS: It was a observational prospective study done from January 2014 to April 2015 in Department of Obstetrics and Gynaecology, NDMC Medical College and Hindu Rao Hospital, Delhi, India. A total of 100 women with singleton pregnancy, between 24 and 36 weeks of gestation with complaint of uterine contractions were randomly selected. These women were subjected to detect phIGFBP-1 in cervical secretions and cervical length measurement by Transvaginal Sonography (TVS). Result of the test, cervical length and time lapse between test and delivery was noted and the results were analysed. The cervical length less than 25 mm was used as a cut off point for predicting pre-term delivery. Data was analysed using SPSS software version 20.0. RESULTS: The Negative Predictive Value (NPV) of phIGFBP-1 and cervical length was similar (95.2% vs 94.05%) respectively for prediction of preterm labour within one week of admission and 93.92% vs 94.80% at 37 weeks of gestational age. Combined test had higher NPV of 96.38% at 34 weeks of gestation and 94% within two days of admission. Positive Predictive Value (PPV) was low for both the test and combining the two-test did not have any advantage as far as PPV was concerned. Receiver Operating Characteristic (ROC) curve showed that the combined test had a superior result in predicting PTL compared to either phIGFBP-1 or cervical length. The combined test had steepest ROC curve at < 34 weeks of gestation (AUC-0.83 with 95% CI). CONCLUSION: The phIGFBP-1 test and cervical length have an almost equivalent ability to predict preterm delivery independently. The combined use of phIGFBP-1 and TVS for cervical length shows an increase in efficacy in predicting preterm labour.
J Clin Diagn Res
· 2017 Sep · PMID 29207780
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Autoimmune Pancreatitis (AIP) presents in two forms - Type I or lymphoplasmacytic sclerosing pancreatitis and Type II or idiopathic ducto-centric pancreatitis (IDCP). AIP II is rare in south Asia and, especially so, in I...Autoimmune Pancreatitis (AIP) presents in two forms - Type I or lymphoplasmacytic sclerosing pancreatitis and Type II or idiopathic ducto-centric pancreatitis (IDCP). AIP II is rare in south Asia and, especially so, in India. Most patients have either Idiopathic Chronic Pancreatitis (ICP) or alcohol related chronic pancreatitis. AIP Type I has been described in India. We herein report a patient who had features of ICP on imaging, for whom surgery was performed to relieve chronic pancreatic pain. However, the pathologic features revealed AIP Type II or IDCP.
Maghrebi H, Makni A, Rhaeim R
… +2 more, Zehani A, Bensafta Z
J Clin Diagn Res
· 2017 Sep · PMID 29207779
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Intraductal Tubulopapillary Neoplasms (ITPN) is a rare and new entity defined as an intraductal, grossly visible, tubule-forming epithelial neoplasm with high- grade dysplasia and ductal differentiation without overt pro...Intraductal Tubulopapillary Neoplasms (ITPN) is a rare and new entity defined as an intraductal, grossly visible, tubule-forming epithelial neoplasm with high- grade dysplasia and ductal differentiation without overt production of mucin. Its clinical presentation can be varied, which makes the diagnosis quite challenging. In this report, we present a case of pancreatic ITPN and review the published work to learn clinicopathological, radiological features and treatment strategies of this recently proposed pancreatic neoplasm.
J Clin Diagn Res
· 2017 Sep · PMID 29207778
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A 13-year-old girl, who did not receive any treatment for few hours following Road Traffic Injury (RTI), reported to the Casualty Department and found to have patent airway with clinically normal C spine, air-hunger (RR...A 13-year-old girl, who did not receive any treatment for few hours following Road Traffic Injury (RTI), reported to the Casualty Department and found to have patent airway with clinically normal C spine, air-hunger (RR 42/minute), trachea deviated to left, distended neck veins and absent breath sounds on the right side. The chest X-ray she carried, done immediately after the injury, showed right sided tension pneumothorax. She was put on oxygen at 11 L/minute and an Intercostal chest tube drainage (ICD) was inserted on right side. Her oxygen saturation (40%) failed to improve. ICD bag showed continuous bubbling and air entry remained absent on the right side. An urgent right thoracotomy was done which revealed right main bronchus tear; the tear was repaired using interrupted Prolene sutures. Patient recovered well and was discharged 10 days later in a stable condition.
Ravindhran B, Prakash C, Govindharaj S
… +2 more, Bahnou NMS, Pavithra B
J Clin Diagn Res
· 2017 Sep · PMID 29207777
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Diffuse Large B-Cell Lymphoma (DLBCL) is the most common histological subtype of Non-Hodgkin's Lymphoma (NHL). Primary retroperitoneal DLBCL is uncommon and has seldom been reported. Extrinsic compression of the duodenum...Diffuse Large B-Cell Lymphoma (DLBCL) is the most common histological subtype of Non-Hodgkin's Lymphoma (NHL). Primary retroperitoneal DLBCL is uncommon and has seldom been reported. Extrinsic compression of the duodenum due to lesions originating from the retroperitoneum is also rare. We present a case of a 39-year-old man who presented with inability to tolerate oral intake, abdominal pain, an upper abdominal mass and postprandial bilious vomiting caused by a large DLBCL arising from the retroperitoneum causing extrinsic compression of the duodenum. The cause of compression was initially presumed to be a neoplasm arising from the uncinate process of the pancreas or duodenum because of its proximity to the uncinate process and apparent widening of the C loop of duodenum. Repeat Computed Tomography (CT) scans were obtained because of the rapid increase in the size of the mass, normal levels of tumour markers such as Cancer Antigen (CA) 19-9, Carcinoembryonic Antigen (CEA) and no evidence of jaundice in spite of the large size of the mass. It revealed encasement of the uncinate process of pancreas with no involvement of parenchyma of the pancreas, thereby mimicking a pancreatic tumour. The neoplastic lymphoid cells were positive for Leukocyte Common Antigen (LCA), Cluster of Differentiation (CD)20, CD10, B-cell Lymphoma 2 (Bcl-2) and were negative for Creatine Kinase (CK), CD23, CD30, Anaplastic Lymphoma Kinase (ALK) and cyclin D1, D3 and D5. The Ki67 proliferative index was greater than 95%. Retroperitoneal DLBCL although rare should be considered in cases of duodenal obstruction.
Gupta R, Gupta S, Basu S
… +2 more, Dey P, Khan IA
J Clin Diagn Res
· 2017 Sep · PMID 29207776
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Primary Urethral Carcinoma (PUC) is considered as a rare tumour, accounts for less than 1% of all malignancies and an incidence rate of four cases per million patients. Incidence increases with the patient's age and most...Primary Urethral Carcinoma (PUC) is considered as a rare tumour, accounts for less than 1% of all malignancies and an incidence rate of four cases per million patients. Incidence increases with the patient's age and most commonly present in seventh decades. Urothelial carcinoma is the most common type (76%) of the PUC, adenocarcinoma accounts for less than 5% of the PUC. No definitive protocol for tumour management for urethral adenocarcinoma has been described in the literature due to lack of prospective study and scarcity of the cases. Treatment usually depends on the site and stage of the tumour. We hereby report a case of 33-year-old male patient with urethral adenocarcinoma of bulbomembranous urethra spread to the prostatic urethra and left side inguinal lymph node. He was treated through multimodal therapy with surgery plus adjuvant chemotherapy.
Parab SV, Salve PG, Dahiphale A
… +2 more, Thakare R, Aiwale A
J Clin Diagn Res
· 2017 Sep · PMID 29207775
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Meckel's Diverticulum (MD) is the most common congenital anomaly of gastrointestinal tract, occurring in 2% of the population. It is a true diverticulum and histologically all four intestinal layers are present within MD...Meckel's Diverticulum (MD) is the most common congenital anomaly of gastrointestinal tract, occurring in 2% of the population. It is a true diverticulum and histologically all four intestinal layers are present within MD. There are various complications related to a Meckel's diverticulum, including haemorrhage, intestinal obstruction, inflammation and perforation. Axial torsion followed by gangrene of MD is the rarest of the complications that have been reported. The exact mechanism for torsion is unclear. Preoperative diagnosis of torsion of MD is difficult and often confused with appendicitis as pain is usually localized to right lower quadrant. Radiological investigations do not provide much help in diagnosis. We report a case of axial torsion of MD presenting as acute abdomen in an 11-year-old female patient. The diagnostic laparoscopy was performed. Confirmatory diagnosis and further surgical management was done by exploratory laparotomy under general anaesthesia.
J Clin Diagn Res
· 2017 Sep · PMID 29207774
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Gastrointestinal Stromal Tumours (GISTs) are tumours of the gut found mostly in stomach and small intestine. The complications are Gastrointestinal (GI) bleeding, obstruction, pain and rarely perforation. We are reportin...Gastrointestinal Stromal Tumours (GISTs) are tumours of the gut found mostly in stomach and small intestine. The complications are Gastrointestinal (GI) bleeding, obstruction, pain and rarely perforation. We are reporting an abnormal presentation of GIST masquerading as an acute abdomen with Right Iliac Fossa (RIF) mass in 60-year-old lady. Contrast Enhanced Computed Tomography (CECT) of abdomen revealed a peripherally enhancing encapsulated abscess in RIF in close contact with base of caecum and adjacent peritonitis suggesting caecal perforation. On laparotomy, a gangrenous perforated ileal GIST was identified along the antimesenteric border of ileum. Pathological examination confirmed the tumour to be a GIST of spindle cell type, further reiterated by immunohistochemistry. Our case report emphasizes, GIST as a rare and unusual differential diagnosis of RIF mass, and to have high degree of clinical suspicion when a similar situation is encountered in an emergency scenario, keeping in mind the poor outcome due to delay in appropriate management of the disease.
Mittal J, Dorairajan LN, Manikandan R
… +2 more, Bade BA, Mishra A
J Clin Diagn Res
· 2017 Sep · PMID 29207773
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Carcinoma prostate secondary metastasis to testicle and epididymis is rare. We report a case of metastatic carcinoma prostate in which testicular and epididymal metastasis were diagnosed incidentally in bilateral orchiec...Carcinoma prostate secondary metastasis to testicle and epididymis is rare. We report a case of metastatic carcinoma prostate in which testicular and epididymal metastasis were diagnosed incidentally in bilateral orchiectomy specimen. Testicular and para testicular structure should be properly evaluated for accurate staging of carcinoma prostate. Epididymis should always be included in bilateral orchidectomy specimen.
Nezafati S, Khiavi RK, Mirinejhad SS
… +2 more, Ammadi DA, Ghanizadeh M
J Clin Diagn Res
· 2017 Sep · PMID 29207772
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INTRODUCTION: Pain is an unpleasant feeling due to tissue destruction, which disturbs an individual's daily routines even at its lowest levels. The majority of surgeons and anaesthesiologists are increasingly trying to a...INTRODUCTION: Pain is an unpleasant feeling due to tissue destruction, which disturbs an individual's daily routines even at its lowest levels. The majority of surgeons and anaesthesiologists are increasingly trying to administer non-opioid analgesics because excessive use of opioids after surgery results in patient dissatisfaction. AIM: To evaluate the analgesic effect of intravenous injection of different doses of ketorolac at different intervals in patients undergoing surgery for unilateral fractures of the mandible. MATERIALS AND METHODS: In the present randomized clinical trial (March 2016 to January 2017, in Tabriz Imam Reza Treatment/Educational Center), 50 patients were assigned to five groups with simple randomization method. In Group 1 and 2, immediately before the induction of general anaesthesia 30 and 60 mg of ketorolac and in Group 3 and 4, immediately before termination of surgery 30 and 60 mg of ketorolac was injected intravenously. In Group 5, ketorolac was not administered. After each patient regained complete consciousness, the severity of pain was determined using VAS up to 24 hours at baseline and at 2, 4, 6, 12 and 24-hours intervals. The total dose of the opioid analgesic agent (morphine-pethidine) and the time for the first request for an analgesic agent were recorded for each patient and their means were compared in each group with suitable statistical tests. RESULTS: The patients in Group 5 and 4 exhibited the highest and lowest mean pain scores (5.03±0.9 and 3.5±1), respectively. ANOVA for repeated measures and post-hoc Tukey tests showed significant differences only between Group 3 and 5 (p=0.002) and Group 4 and 5 (p=0.001), with no significant differences between the other groups (p>0.005). The highest dose of the analgesic agent was in Group 5 (5.3±1.4 mg) and the lowest dose was recorded in Group 4 (1.6±0.6 mg). Patients in the control group received significantly higher doses compared to the other groups (p<0.05). The patients in Group 1 and 2 received higher doses of analgesics compared to Group 3 and 4 (p<0.05). The longest time for the request for the first dose of analgesic agent after surgery was 73.4±12.03 minutes in Group 4 The patients in the control group had requested analgesics after surgery at a significantly shorter time compared to the patients in all the study groups (p<0.05). The patients in Group 1 and 2 had requested analgesics at a shorter time after surgery compared to the subjects in Group 3 and 4 (p<0.05). CONCLUSION: Intravenous administration of 30 and 60 mg of ketorolac, immediately before termination of surgery, decreases the pain severity and the need for opioid analgesics after surgery.
Krishnamoorthy S, Palaniyandi V, Kumaresan N
… +5 more, Govindaraju S, Rajasekaran J, Murugappan I, Ramanan V, Krishnan MN
J Clin Diagn Res
· 2017 Sep · PMID 29207771
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INTRODUCTION: Genito Urinary Tuberculosis (GUTB) is a widespread disease seen in urology practice. The true incidence and prevalence of GUTB is difficult to estimate because a large number of patients remain asymptomatic...INTRODUCTION: Genito Urinary Tuberculosis (GUTB) is a widespread disease seen in urology practice. The true incidence and prevalence of GUTB is difficult to estimate because a large number of patients remain asymptomatic. AIM: To recognize typical and atypical clinical and radiological features of tuberculosis and to emphasize the need for diagnosing GUTB early. MATERIALS AND METHODS: This was a retrospective study conducted in 110 cases of GUTB diagnosed and treated in two teaching institutions over a period of three years, from July 2002 to June 2005. A detailed history, thorough clinical examination, urine examination, culture for tubercle bacillus, imaging studies, cystoscopy and histological and serological examination were done to arrive at a diagnosis. RESULTS: Fifty six patients (51%) were in the age group of 21-40 years. The male: female ratio was 1.4: 1. Loin pain was the most common symptom observed in 27% of the patients. Intravenous Urogram (IVU) revealed non-visulalised kidney in 25 patients (23%), hydronephrosis or hydrouretero nephrosis in 34 patients (31%) and distortion, cavitation or scarring of the calyces in 16 patients (14.5%). Five of them had thimble bladder. In 14 patients, IVU appeared normal. About 28 patients (25%) were treated conservatively with anti tuberculosis therapy. Twenty one of them (19%) underwent Nephrectomy and 10 patients had reconstructive procedures. CONCLUSION: A peculiarity of most of our patients was a late presentation with advanced disease. Most patients were asymptomatic or ignorant. Slow but continuous infection causes a destruction of renal parenchyma and the healing process leads to renal parenchymal loss. If identified early and treated appropriately, GUTB is a curable condition.
J Clin Diagn Res
· 2017 Sep · PMID 29207770
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Nutrition management is one of the cornerstones of care in the management of hospitalized patients, especially, for those who are critically ill. Significant numbers of hospitalized patients have alteration in appetite a...Nutrition management is one of the cornerstones of care in the management of hospitalized patients, especially, for those who are critically ill. Significant numbers of hospitalized patients have alteration in appetite and the function of the gastrointestinal tract. Calculating the caloric goal, prescribed proteins to be delivered in a finite amount of water at a certain rate is the need of the hour and it becomes a daunting task to complete daily. With the help of technology such tasks can be completed easily and accurately. This suggestion based software called as "iNutriMon" helps to screen out the patients which are at risk of malnutrition, formulate a plan, monitor and manage enteral nutrition of patients by calculating calories, proteins and water intake as per the patient requirement.
Uddin MF, Alweis R, Shah SR
… +5 more, Lateef N, Shahnawaz W, Ochani RK, Dharani AM, Shah SA
J Clin Diagn Res
· 2017 Sep · PMID 29207768
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Over the past few years, Serotonin Syndrome (SS) has become a significant clinical concern. Over the last decade, United States saw a surge in antidepressant use. SS characteristically presents as the triad of altered me...Over the past few years, Serotonin Syndrome (SS) has become a significant clinical concern. Over the last decade, United States saw a surge in antidepressant use. SS characteristically presents as the triad of altered mental status, autonomic dysfunction and neuromuscular excitation. Symptoms vary from patient to patient with mild cases presenting with subacute symptoms and severe cases progressing rapidly to death. Due to the protean manifestations of the syndrome along with non-specific prodromal, SS can easily be misdiagnosed if not carefully assessed. In severe cases, SS can be mistaken as neuroleptic malignant syndrome while mild cases are mostly misattributed to other causes such as flu. SS is a clinical diagnosis and therefore, requires a thorough review of medications and physical examination. Given the protean nature of this toxicologic syndrome various criteria were defined which includes Sternbach's, Radomski and Hunter's criteria. Keeping in mind the wide symptoms of serotonin syndrome from being barely perceptible to lethal emphasis there is a need to treat the syndrome on urgent basis. Mainstay for treatment of serotonin syndrome is to discontinue the offending drug. Improvement is seen in most patients within 24 hours.