Derangement Research Articles

Evaluation of the outcome of laparoscopic one anastomosis gastric bypass among obese patients with type 2 diabetes mellitus; a prospective study

Background Laparoscopic one-anastomosis gastric bypass (OAGB) was introduced as a simple (one anastomosis) operation combining both restrictive and malabsorptive functions, thus suitable for obese patients with metabolic derangements like type 2 diabetes mellitus (T2DM). The aim of this study was to evaluate the outcome of OAGB among obese patients with T2DM. Patients and methods A sample of 40 individuals with a BMI greater than 35 kg/m2 and T2DM was prospectively recruited from the obesity clinic, Suez Canal University teaching hospital and Suez Canal Authority hospital, city of Ismailia, Egypt. The patients underwent laparoscopic OAGB operation and were offered a follow-up for a period of 12 months. Results The mean;Deg;BM;Deg;I of the patients demonstrated a statistically significant decline from 49.2 kg/m2 preoperatively to 34.2 kg/m2 at the end of the follow-up. Regarding diabetes status, the mean fasting blood sugar decreased significantly from 226 to 104 mg/dl. Moreover, the mean glycosylated hemoglobin decreased from 8.4 to 6.3%. Overall, 42.5% of the patients showed complete diabetic remission at the end of the follow-up, whereas 35% showed partial remission. The rest of the patients (22.5%) did not fulfill the criterion, yet showed improvement in their fasting blood sugar and glycosylated hemoglobin levels from their preoperative values. Conclusion Laparoscopic OAGB had proved to be an effective surgical treatment for both obesity and T2DM.

Coagulopathy Characterized by Rotational Thromboelastometry in a Porcine Pediatric ECMO Model.

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used to support patients with reversible cardiopulmonary insufficiency. Although it is a lifesaving technology, bleeding, inflammation, and thrombosis are well-described complications of ECMO. Adult porcine models of ECMO have been used to recapitulate the physiology and hemostatic consequences of ECMO cannulation in adults. However, these models lack the unique physiology and persistence of fetal forms of coagulation factors and fibrinogen as in human infants. We aimed to describe physiologic and coagulation parameters of piglets cannulated and supported with VA-ECMO. Four healthy piglets (5.7-6.4 kg) were cannulated via jugular vein and carotid artery by cutdown and supported for a maximum of 20 hours. Heparin was used with a goal activated clotting time of 180-220 seconds. Arterial blood gas (ABG) was performed hourly, and blood was transfused from an adult donor to maintain hematocrit (Hct) > 24%. Rotational thromboelastometry (ROTEM) was performed at seven time points. All animals achieved adequate flow with a patent circuit throughout the run (pre- and post-oxygenator pressure gradient <10 mmHg). There was slow but significant hemorrhage at cannulation, arterial line, and bladder catheter sites. All animals required the maximum blood transfusion volume available. All animals became anemic after exhaustion of blood for transfusion. ABG showed progressively declining Hct and adequate oxygenation. ROTEM demonstrated decreasing fibrin-only ROTEM (FIBTEM) clot firmness. Histology was overall unremarkable. Pediatric swine are an important model for the study of pediatric ECMO. We have demonstrated the feasibility of such a model while providing descriptions of physiologic, hematologic, and coagulation parameters throughout. Weak whole-blood clot firmness by ROTEM suggested defects in fibrinogen, and there was a clinical bleeding tendency in all animals studied. This model serves as an important means to study the complex derangements in hemostasis during ECMO.

Endoscopic Ultrasound Can Determine the Cause of Most Cases of Idiopathic Acute Pancreatitis

Cases of acute pancreatitis usually have an obvious etiology (e.g., gallstone disease, medications, alcohol, metabolic derangements), but a small

Magnetic resonance imaging of temporomandibular joint disorders

Objective The aim was to highlight the role of MRI in the evaluation of temporomandibular joint (TMJ) disorders. Background MRI has become a mainstay in the evaluation of TMJ disorders given its ability of noninvasively depicting major regional anatomic structures and demonstrating the presence of joint effusion and bone marrow signal-intensity abnormalities. Consequently, MRI has become the gold standard in diagnosing articular disc displacement. Patients and methods In this study, we included 30 patients (60 joints) who were referred from dentist's and rheumatologist clinics. They had clinical manifestations of TMJ affection. They were subjected to clinical history and examination. The main tool for diagnostic assessment was the conventional MR study of the TMJ in both opened and closed mouth positions. Results This study suggests the use of MRI as a proper diagnostic modality for TMJ disorders owing to the excellent soft tissue contrast and multiplanar capabilities that enable enhanced demonstration of complex anatomy and superior assessment of the pathological conditions of the TMJ, especially internal derangement of the TMJ. Conclusion There were 28 normally positioned discs out of the examined 60 joints. There were 13 joints showing partial anterior disc displacement (ADD) with reduction. We found five joints showing partial ADD without reduction. We found 13 joints showing complete ADD without reduction. We found one joint showing osteoarthritis.

Endocrinological Management of Sellar and Supra-Sellar Tumors in Children.

CNS tumours and their treatment commonly lead to endocrinopathies in children. Advances in surgical techniques, chemotherapy and radiotherapy have improved the survival in children with CNS tumours however they have also added to the late effect burden. Since the pituitary and hypothalamus regulate many important bodily functions, loss in their function leads to major derangements in growth and hormonal milieu. This article is a review of clinical presentation, diagnosis and management of endocrinopathies encountered in common sellar and supra-sellar CNS tumours in children. The management is divided into mainly two sections: immediate (peri and post-operative) and long term.

Vataja Unmada: Schizophrenia or Dementia or Mood Disorder with Psychosis?

Unmada (a broad term which includes different psychiatric conditions under one umbrella) is characterized by the derangement of manas (mind), buddhi (cognitive functions), samgna gnana (orientation), smriti (memory), bhakti (interests), sheela (character/personality), cheshtha (psychomotor activity/behavior), and achara (conduct). Unmada is classified into five (vataja, pittaja, kaphaja, sannipataja and agantuja) types, and “Vataja Unmada” (VU) is one among them. The description of VU is available in all major Ayurvedic classical texts, and it comes under “Doshaja” (psychiatric disorder which occurs due to the aggravation of doshas) category. Studies or scientific literature on VU has been lacking, and the present work is focused on to explore this condition. The etiopathology of VU denotes deficiency of various nutritional factors such as vitamins, minerals, omega-3-fatty acids, amino acids, and antioxidants. Lacking or deficiency of these nutritional factors leads to structural and/or functional damage and degeneration of the brain (neurodegenerative or demyelinating pathology) which ultimately leads to the manifestation of different degenerative psychiatric disorders. The clinical picture of VU resembles various psychiatric or neuropsychiatric conditions such as “disorganized schizophrenia” or “hebephrenia” or “catatonia” or “dementia” or “bipolar disorder with psychotic features” or “mania with psychotic features,” or “organic or secondary psychoses.” VU is a treatable condition, and it can be managed successfully by “Panchakarma” procedures along with internal medicines.

Influences of Xinnaoning capsules on aorta calcium sensing receptor of rats with myocardial infarction and endothelial protection mechanisms based on the theory of phlegm and blood stasis

Objective To observe the impacts of Xinnaoning capsules on the aortic intimal structure, serum levels of diponectin (APN) and calcium sensing receptor (CaSR) expression in rats with myocardial infarction, and explore the endothelial protection mechanisms of Xinnaoning. Methods 15 male Sprague Dawley (SD) rats in sham operation group were randomly selected from 60 rats, the rest 45 rats were fed with high fat diet for 6 weeks and received coronary artery ligation operation. The successful modeling rats were randomly divided into model group, western medicine group and traditional Chinese medicine(TCM) group, and fed with high fat diet for 8 weeks. The sham operation group fed with normal diet. The western medicine group and TCM group received atorvastatin and Xinnaoning capsules, respectively; the sham operation group and model group received same amount of distilled water. After treatment of 4 weeks, the aortic intimal structure was observed by hematoxylin-eosin (HE); the serum levels of triacylglycerol (TG), total cholesterol (TC), low density lipoprotein (LDL) and high density lipoprotein (HDL) were measured by microplate test; serum levels of APN and CaSR expression were determined by enzyme linked immunosorbent assay (ELISA) and Western blot, respectively. Results Compared with sham operation group, aortic intimal structure derangement and plaque formation in intima in model group, and serum levels of TG, TC, LDL and CaSR expression were increased; HDL and APN were decreased (P 0.05). Conclusions Xinnaoning capsules are effective for myocardial infarction. Key words: Myocardial infarction; CARDIOVASCULAR AGENTS (TCD); Adiponectin; Receptors, calcium-sensing; Rats

Cardiovascular risk prediction in the elderly.

Heart failure (HF) in the elderly, besides being a leading cause of mortality and morbidity, is rapidly increasing in prevalence with patients aged 65 and older accounting for more than 75% of heart failure hospitalizations. Elderly patients have historically been unrepresented in clinical HF trials and often present with multiple comorbidities, including frailty, depression, nutritional, functional and cognitive impairments. Additionally, pharmacologic challenges such as adherence to therapy, polypharmacy, altered drug pharmacokinetics and/or renal derangements make them less likely to receive guideline-directed medical therapies for HF. Recognition of these various interrelated domains is key and should prompt a multidisciplinary, holistic management approach so as to optimize prognosis in this vulnerable subset of the population.

Regional anticoagulation in renal replacement therapy

Continuous renal replacement therapy (CRRT) has become the standard treatment for acute kidney injury or severe metabolic derangement in the pediatric intensive care unit.Anticoagulation for circuit patency is the prerequisite during CRRT operation.Regional citrate anticoagulation for CRRT is more effective and safe than systemic or regional heparin.Regional citrate anticoagulation can decrease the risk of circuit loss and filter failure; furthermore, it is safer than systemic heparin anticoagulation for the reduction of bleeding risk.Complications of citrate anticoagulation(such as acid-base imbalance and electrolyte disturbances) can be avoided by using an appropriate protocol and regular monitoring.Therefore, citrate should be considered as the first choice for anticoagulation during CRRT in critically ill pediatric patients, and further studies are needed to evaluate the safety and efficacy of citrate anticoagulation in the pediatric population. Key words: Continuous renal replacement therapy; Citrate; Heparin; Regional anticoagulation

Effect of PCI on Cardiac Function in Chronic Stable Angina Patients with âNormalâ Ejection Fraction: A Tissue Doppler Study

Background: Patients with stable coronary artery disease may have subtle derangements in their cardiac function before evident changes occur in conventional echocardiography-derived ejection fraction (EF). These derangements manifest firstly in the longitudinal before circumferential LV function. The effect of percutaneous coronary intervention (PCI) on ventricular function in patients with chronic stable angina has shown controversial results. In the current study, we tried to assess the impact of PCI on myocardial systolic and diastolic function using different noninvasive indices in patients with stable coronary artery disease. \ Methods: A total of 50 patients scheduled for elective PCI were enrolled in this study. All had chronic stable angina and a left ventricular ejection fraction>55%. All underwent echocardiographic evaluation of left ventricular function using EF and Myocardial Performance Index (MPI), in addition to pulsed-wave tissue Doppler imaging (TDI) at the mitral and lateral tricuspid annulus. All indices were measured one day before and 5 days after PCI. Results: 44% of the patients were males and 56% were females. The mean age was 55.5 ± 9.1 years. There was a significant improvement of the mean systolic myocardial velocity S′ wave in the LV as a whole and the lateral RV annulus 5 days after intervention irrespective of the lesion site. There was also a highly significant improvement in anterior S′ wave velocities 5 days after intervention. Conclusion: Pulsed wave tissue Doppler is more sensitive in postPCI monitoring and follow up of systolic function in patients with chronic stable angina and seemingly normal baseline cardiac function

Recent Concepts in Nutritional Therapy in Critically Ill Burn Patients

In developing countries such as India, burn injury is still a major and frequent cause of mortality and morbidity. Nutrition therapy aims to provide adequate and early nutrition for patients suffering from burn injuries. Metabolic support during heightened inflammatory state is essential to make sure adequate treatment of burn patients. It is essential to reduce the force and effects of the hypermetabolic response, aim for healing of wounds, and help to reduce negative catabolism effects. At the same time, care of surgical and medical needs of the patient is crucial for good clinical outcomes. Nutritional sustain is an essential and integral component of burn care that requires an aggressive multifaceted approach. Impaired wound healing, dysfunction of multiple organs, increased chances of infection, and death are largely prevented by an adequate nutrition care along with proper wound management. Catecholamine and corticosteroids, inflammatory mediator levels, are increased, and this hypermetabolic response leads to catastrophic results in the postburn injury period. A shift from preventing malnutrition to disease modulation in nutrition support in critically ill patients is being aimed at present. Uncontrolled inflammation causes severe metabolic derangement in burn patients. Major challenges are assessment of nutritional status of the patient and estimation of nutrient requirements. Careful decision-making for safe use of enteral or parenteral nutrition and an aggressive nutrient delivery are required. The course of disease can be altered favorably to a great extent by supplementation of specific nutrients. Nutritional factors with positive effects on immunity and in cell regulation include glutamine, arginine, and essential fatty acids, known as immunonutrients. They reduce the severity of illness and improve response to treatment of patients. Nutrition support specialists are trying to improve the management protocols and technological advances such as nanotechnology and biomarkers will take the nutrition management to greater advances.

Feline Epilepsy: An Update

Seizures are the most common neurological disorder in the clinical setting. Its etiology is multifactorial and is mainly divided into primary and secondary epilepsy. Secondary epilepsy can be caused by vascular events, inflammatory conditions (encephalitis), toxins, traumatic injuries, metabolic derangements, neoplasia, congenital and inherited (degenerative) disorders. Although primary (idiopathic) epilepsy was thought to be rare in cats, it is now established as a common cause. Seizures in cats appear with various clinical presentations including the typical generalized tonic-clonic, focal with or without secondary generalization seizures, or solely as behavioral changes. Type of seizures is not indicative of their etiology. Diagnostic investigation is crucial in order to establish final diagnosis and to determine the therapeutic plan. Diagnostics include physical and neurological examination with detailed history (drug or toxin exposure), routine hematology (CBC, biochemistry, urinalysis), specific laboratory tests if concurrent or metabolic disease are suspected, advanced diagnostic imaging (CT/MRI) whether intracranial disease is suspected and cerebrospinal fluid (CSF) analysis. Most commonly used antiepileptic drugs (AED) in cats are phenobarbital and levetiracetam. Bromide is contraindicated in cats due to severe respiratory disease caused as an adverse life-threatening reaction. Diazepam is an emergency AED used to eliminate cluster seizures or status epilepticus but it should be avoided as a long-term medication because it has been associated with fatal hepatotoxicity. Gabapentin in another potential antiepileptic drug however its long-term efficacy has to be evaluated. Prognosis depends on the underlying etiology and treatment response. In most cats quality of life is improved and (>50% reduction of seizures) regardless of etiology. The complete remission of seizures in cats is rare and most cats should be maintained on anti-epileptic therapy.

Air pollution and childhood asthma

Air pollution plays an important role in the occurrence and development of childhood asthma and is one of the risk factors of asthma.In daily life, there are a great variety of air pollutants.They have a wide range of sources.They can increase the risk of asthma onset and acute exacerbations, impair the lung function of children, lead to immunologic derangement, enhance allergenicity and reduce the responsiveness to treatment via various mechanisms and signal pathways.Age, gender, obesity, sensitization, antioxidants supplement, protective measures and other factors impose the adverse effects of pollutants on the children.Although some progress has been made in the research of air pollution and asthma in children, many problems are still needed to be further explored.This review summarizes the common air pollutants on the initiation and evolution of childhood asthma. Key words: Air pollution; Children; Asthma

Oxidative stress as a possible mechanism underlying multi-hormonal deficiency in chronic heart failure.

Chronic Heart Failure (CHF) is associated with multi-hormonal derangement depicting a prevalence of catabolic vs. anabolic axes. Moreover, thyroid adaption is characterized by the reduced conversion of thyroxine to the active hormone triiodothyronine. On the other hand, hormones modulate synthesis and utilization of antioxidant systems. Therefore, hormonal failure can cause unbalance between reactive radical species and the defenses, resulting in oxidative stress (OS). OS is well described in CHF, but the relationship with the hormonal picture is not entirely known. In the present review, we firstly analyze the mechanisms of ROS production in the heart, discussing animal and human studies, and focusing on new discovered protective mechanisms such as sirtuins and fibroblast growth factor 21 (FGF21). The second section is dedicated to the role of main anabolic axes influencing antioxidant systems. Finally, we present some data supporting the hypothesis that OS could be the link between hormonal derangement and clinical outcome of CHF.

Associations in Electronic Data Warehouse Elements of Neonatal Hypoxic-ischemic Encephalopathy and Length of Stay

Background: Neonatal hypoxic-ischemic encephalopathy (HIE) is often accompanied by physiologic derangements and organ dysfunction; however, the natural history of these perturbations and their relationship with length of stay (LOS) remains uncertain. Objective: To describe daily markers of physiologic and organ dysfunction in infants with HIE and test their association with LOS in the neonatal intensive care unit. Methods: Eligible subjects were infants with HIE born ≥36 weeks' gestation from 2010-16 and received therapeutic hypothermia. Those with major congenital anomalies were excluded. From our institution’s electronic data warehouse (EDW), we …

The possibility of hormone-mediated PSA derangement in prostate cancer treatment

The possibility of hormone-mediated PSA derangement in prostate cancer treatment

Clinicopathological Correlation of Portal Hypertension in Children and Management Strategies

We studied 51 children with clinical setting of portal hypertension over a period of one and half years. Out of these, 27 (52.94%) were males and 24 (47.05%) were females. All the cases were subjected to biochemical, diagnostic, radiological investigations and liver biopsy. Portal hypertension was diagnosed by demonstrating on USG abdomen/ Doppler, the presence of collaterals of portal vein and esophageal varices on endoscopy. Treatment was initiated depending upon clinical presentation. The most common presenting complaints were hematemesis and malena (35.3%) followed by their combination with abdominal distension (19.6%). 86.3% patients had anemia mostly due to upper GI bleed. 35.3% patients had leucopenia while 47.1% had thrombocytopenia. Only 18 (i.e. 35.3%) had Hypersplenism. Maximum patients who bled more than twice had a mild (41.2%) or severe (29.4%) derangement of prothrombin time. The etiology of portal hypertension turned out to be extra- hepatic portal vein obstruction in 86.3% cases. There were 2 cases each (3.9% each) of Wilson’s disease and Budd-Chiari syndrome. One (2%) was secondary to chronic liver disease due to hepatitis C infection, one was extra- hepatic biliary atresia and one was autoimmune hepatitis. 9.8% cases required drugs in the form of somatostatin drip and all these required a packed cell transfusion as well. 23 patients (45.1%) required only blood transfusion without a somatostatin infusion. Those with severe acute bleeding usually were given somatostatin infusion. The variceal size at presentation was a very important predictor of the morbidity and outcome.

McKenzie mechanical syndromes coincide with biopsychosocial influences, including central sensitization: a descriptive study of individuals with chronic neck pain

BackgroundMechanical diagnosis and therapy (MDT) aims to assess and classify patients into theoretically mutually exclusive subgroups, in order to direct treatment. However, the latest evidence for biopsychosocial influence–central sensitization (CS) and psychological distress–have not been assessed in conjunction with MDT.Objectives(1) Determine the percentage of patients categorized into the MDT subgroups; (2) characterize the biopsychosocial clinical profile (presence of CS and psychological distress); and (3) identify associations between pain, disability, and biopsychosocial influences among this cohort.MethodsEighty four patients with chronic neck pain were recruited by 10 certified MDT therapists using a convenience (consecutive) sampling method. Patients were evaluated using MDT principles and also completed an online survey to measure CS (using the Central Sensitization Inventory [CSI]), pain catastrophizing and kinesiophobia.ResultsThe proportions of the subgroups derangement (DER), dysfunction, postural and ‘other’ were 74.4, 2.4, 1.2, 20.7%, respectively. CS was observed in 62% of our sample (CSI score ≥ 40). CS was also observed in 64.7% of patients of the DER subgroup. Almost half of our sample (47.8%) demonstrated the co-occurrence of CS and DER, while 38% presented with DER syndrome, CS, and kinesiophobia.ConclusionThe majority of our patients were classified as DER; they also presented with high levels of CS and/or psychological distress. This suggests that MDT mechanical subgroups, particularly DER, can present with co-occurring biopsychosocial influences. Without assessing CS and psychological distress, MDT therapists may miss crucial information. Further research is required to determine the optimal management of patients presenting with mechanical and non-mechanical drivers of pain.

An uncommon knee pain: Ganglion cyst in the gastrocnemius medialis

A large symptomatic ganglion cyst occurring in the gastrocnemius has been infrequently described in the literature. Clinical presentation and management of such a symptomatic ganglion are briefly outlined here. This is perhaps the first case that describes the surgical management of symptomatic ganglion and associated internal derangement of the knee with favorable outcomes.

Disseminated intravascular coagulation scoring in children with newly diagnosed acute leukemia

Background Patients with acute leukemia (AL) commonly present with abnormalities in laboratory tests of blood coagulation. Coagulation abnormalities and disseminated intravascular coagulation (DIC) have been extensively studied in acute promyelocytic leukemia, but only a limited number of studies addressed this issue in children with other types of AL. Objective The aim of this study was to detect DIC by using the International Society of Thrombosis and Haemostasis scoring system, for both nonovert and overt DIC, among newly diagnosed children with AL. Participants and methods The study was a diagnostic test accuracy study including 25 children presenting with newly diagnosed AL (lymphoblastic and myeloid) and admitted to the Hematology–Oncology Unit at Alexandria University Children’s Hospital. They were consecutively recruited between October 2016 and March 2017. Coagulation studies including prothrombin time, D-dimer, fibrinogen, antithrombin III, and protein C levels were assessed, and the International Society of Thrombosis and Haemostasis scoring system was used for defining nonovert and overt DIC. Results The age of patients included in the present study ranged from 17 to 149 months, with a median of 48 months; males and females were almost equally represented. At baseline assessment, 10 (40%) of 25 patients had a positive overt DIC score and only seven (28%) of 25 had a positive nonovert DIC score. Bleeding manifestations were a common problem in the present study, as 16 (64%) patients presented with bleeding symptoms, being more frequently in patients with an overt DIC positive score (P=0.040). The median platelet count (P=0.023), D-dimer level (P=0.000), and fibrinogen level (P=0.010) showed a significant statistical difference between patients with either positive or negative overt DIC score, whereas neither white blood cells count, absolute blasts count, hemoglobin, prothrombin time, antithrombin III nor protein C levels did. Conclusion Our data confirm that children with AL have some hemostatic derangement at baseline. A positive overt or nonovert DIC score was not statistically related to a worse end of induction remission status or a significantly higher 28-day mortality rate. Larger multicenter studies are needed to determine the most clinically relevant hemostatic abnormalities and adapt more sensitive and specific scoring system for DIC in children with hematological malignancies.