Group IB Patients Research Articles

Diagnostic efficacy of metaepiphyseal osteomyelitis in young children: a prospective study

INTRODUCTION: Modern and effective diagnosis of osteomyelitis is the basis for successful therapy; at the same time the problem of establishing this pathology, especially in the early stages of the development of the process, has not been completely resolved.OBJECTIVE: To develop of ultrasound imaging of metaepiphyseal osteomyelitis in young children, depending on the duration of the disease.MATERIAL AND METHODS: 108 children (boys — 65% (70/108), girls — 35 (38/108)) from 1 month to 2 years were examined. Children's age from 2 up to 8 months — 57% (62/108), newborns — 26% (27/108). The age of other children: 12% (13/108) — 9–12 months, 5% (6/108) — 1– 2 years. All children underwent x-ray and ultrasound study. The diagnosis of osteomyelitis was verified by joint puncture (n=102), bone puncture (n=57), drainage of periarticular phlegmon (n=12).Statistics: processing of the study results was carried out using the Statistica 13.0 application package (TIBCO Software Inc, 2017). To assess the effectiveness of ultrasound in the diagnosis of acute osteomyelitis, the diagnostic effectiveness and predictive value of positive or negative results were calculated, and the likelihood ratio was calculated.RESULTS: 3 groups were identified depending on the duration of the disease at the time of admission to the hospital: Ia — 1–3 days, Ib — 4–7 days, Group II — 8–14 days, Group III — 15–21 days from the onset of the disease. DE indicators for patients of group Ia: sensitivity — 81.8%, specificity — 60.0%, accuracy — 75%, PV(+)=81.82%; PV(–)=60.00%; OR=4.50. DE indicators for patients in group Ib: sensitivity — 86.6%, specificity — 66.6%, accuracy — 80.95%, PV(+)=87.5%; PV(–)=60.0%; OR=7.00. DE indicators for patients in group II: sensitivity — 92.98%, specificity — 80.0%, accuracy — 93.44%, PV(+)=98.15%; PV(–)=57.14%; OR=37.86. DE indicators for patients of group III: sensitivity — 91.66%, specificity — 91.0%, accuracy — 91.66%, PV(+)=100.0%.DISCUSSION: Ultrasound imaging of acute osteomyelitis in children of group Ia included nonspecific changes in periarticular tissues and had the lowest diagnostic accuracy (75%). Diagnostic accuracy increased in group Ib to 85% due to initial structural changes in the zone of preliminary calcification and hyaline cartilage of the epiphysis. Disease progression in group II was characterized by more distinct structural changes in the metaphysis with an increase in diagnostic accuracy to 93%. In patients of group III, the highest rates of diagnostic accuracy (91.67%) were obtained due to visualization of destructive changes in the epiphysis, metaphysis and zone of preliminary calcification.CONCLUSION: The ability to detect ultrasound signs of acute hematogenous metaepiphyseal osteomyelitis in children will allow the use of this method in the early diagnosis for the timely selection of an adequate treatment tactics.

Effect of physiotherapeutic procedures on the bioelectric activity of the masseter muscle and the range of motion of the temporomandibular joints in the female population with chronic pain: a randomized controlled trial

SummaryIntroductionPhysical therapy (PT) methods applied in dentistry are increasingly discussed nowadays. Taking into account a rapidly growing number of temporomandibular disorders (TMDs) and orofacial pain patients, it is reasonable to determine which of the available physiotherapeutic (PT) methods are more effective than others, especially in terms of their possible analgesic and myorelaxant effects.ObjectiveTo assess manual and physical factors influencing pain reduction or elimination and increased muscle tension in patients with TMD; yet the influence of the applied forms of PT on the range of motion (ROM) of temporomandibular joints (TMJ).Material and methodsA randomized, parallel-group, RCT, single-blind, equi-randomized (1:1) study was conducted in DC/TMD Group Ib patients (20–45 years of age). An experimental group (G1, n = 104) and a control group without TMD (G2, n = 104) were created according to CONSORT guidelines. Diagnostic measurements were performed in both groups (mass sEMG, temporomandibular joint range of motion-ROM, pain intensity - NRS). Group G1 was randomly divided (envelope method) into 4 therapeutic groups, in which therapy was carried out for 10 days: magnetostimulation (MS), magnetoledotherapy (MLE), magnetolaserotherapy (MLA), manual therapy (MT). Each time after the therapy, ROM and NRS measurements were performed, and after the 5th and 10th day sEMG.ResultsStatistically significant differences were found in the sEMG values of the masseter muscles, TMJ ROM and the pain intensity in G1 and G2 (p < 0.00). The largest decrease in sEMG (% MVC) of the masseter muscle occurred in the subgroup in which the manual therapy (MT) procedures were applied, p < 0.000. There was no clinically significant difference in and between other subgroups. There was a distinct mandible ROM increase noted in the MT group, with minimal changes in the MLA and MLE groups and no changes in the MS group. There was a clear increase in the lateral mobility of both right and left TMJ in the MT group. There were no differences in the course of the study in the MS group, and slight increases in the MLA and MLE groups. In the case of pain measurements, the greatest decrease in pain intensity was observed in the MT subgroup.ConclusionsAccording to our results manual therapy is an effective form of treatment in patients with pain, increased masticatory muscle tension and limitation in mandible ROM. Dental physiotherapy should become an integral part of multimodal TMD patients’ treatment.

A Comparison Between Intrathecal Levobupivacaine and Bupivacaine for Quality and Safety During Infraumbilical Surgeries.

Background Levobupivacaine toxicity reports are rare, and when they do occur, toxic symptoms are frequently treatable with minimal morbidity and mortality. However, levobupivacaine has not entirely replaced bupivacaine in clinical practice. Moreover, the experience of intrathecal anesthesia with levobupivacaine is not well documented. Hence, the purpose of this study is to assess the quality and duration of sensory and motor blockade of levobupivacaine and its side effects, if any, compared to intrathecal bupivacaine during infraumbilical surgeries. Methods After approval by the Institutional Ethical Committee of Kurunji Venkatramana Gowda (KVG) Medical College and Hospital, Sullia, 90 patients aged between 18 and65 years, of either sex, who were scheduled for elective abdominoperineal, urological, or lower limb surgeries under intrathecal anesthesia were enrolled in this prospective study fromJanuary 2013 to June 2014. The selected patients were randomly assigned to three groups of 30 each: group HB (3 mL of 0.5% hyperbaric bupivacaine), group IB (3 mL of 0.5% isobaric bupivacaine),and group IL (3 mL of 0.5% isobaric levobupivacaine). Motor blockade was assessed using the modified Bromage scale. Intergroup comparison was done using Tukey's post hoc test. The incidence of adverse effects was analyzed using a chi-squared test. Significance was defined as P<0.05. Results In our study, the mean age of patients in the three groups was comparable (P>0.05), i.e., group IB was 39.23±11.78 years, group HB was 43.63±11.33 years, and group IL was 39.8±12.07 years. The time of onset ofsensory block was 6.57±1.794 minutes in group IB, 2.30±1.343 minutes in group HB, and 4.57±1.960 minutes in group IL, and this variation was statistically highly significant (P<0.001). A total of 15 patients suffered hypotension intraoperatively, of which eight belonged to group HB, four to group IB, and the rest to group IL. Intraoperative or postoperative nausea/vomiting was seen in five patients in group IB, two patients in group HB, and one patient in group IL. In the postoperative period, the mean heart rate (HR) was 77.47±4.88/minute in group IB, 68.78±7.88/minutein group HB, and 72.15±8.83/minute in group IL. The data was statistically highly significant (P<0.001). Conclusion Our study revealed that 15 mg of isobaric levobupivacaine (3 mL of 0.5%), the new racemic isomer of bupivacaine, was intermediate in its anesthetic properties when compared to isobaric bupivacaine and hyperbaric bupivacaine. The onset of sensory and motor blockade is slower than hyperbaric bupivacaine but faster than isobaric bupivacaine with a higher level of maximum sensory block.

EFFECT OF ANTICOAGULANT TREATMENT OF DABIGATRAN AND WARFARIN ON HEMOSTASIS IN PATIENTS WITH LIVER CIRRHOSIS AND ATRIAL FIBRILATION.

The aim of this work. To evaluate and compare standard coagulation parameters and parameters of the low-frequency piezothromboelastography (LPTEG), global test of hemostasis assessment in patients with liver cirrhosis and atrial fibrillation before and after treatment with warfarin and dabigatran, as well as to determine the differences in parameters between patients of both groups.&#x0D; Material and methods. Stage I of the study was prospective, cross-sectional, II stage - randomized experimental study involving 70 patients (46 men and 22 women aged 42 to 83 years), who were divided at second stage into groups IA and received dabigatran at a dose of 110 mg 2g /d, and the IB group, who received warfarin at an initial dose of 5 mg for 3 months. Standard coagulation parameters and low-frequency piezothromboelastography data were assessed in comparison with treatment initiation and between groups. Statistical analysis was performed using the Excel for Windows software package and IBM SPSS Statistics.&#x0D; Results. After treatment with anticoagulant drugs, a statistically significant increase in the INR was revealed by 48.5% (p = 0.035), PT prolongation by 5.4% (p = 0.027) and thrombin time by 19.7% (p˂0.001) compared with initiation of treatment. Group IA showed a significant prolongation of APTT and TT parameters as compared to group IB (p˂0.01), while group IB had prolonged INR, PTI, PT and decreased fibrinogen levels (p˂0.05). According to the LPTEG data, in all patients, the t1 time was prolonged by 33.3%, the ICC index was decreased by 8% (p˂0.05), the CTA was decreased by 46% (p˂0.001), the coagulation time t3 was prolonged (p˂0.001) , parameters ICD, ICP, ITC, MA were significantly reduced by 26.7%, t5 was prolonged (p˂0.001), ICLR was reduced (p˂0.001) and CTAA was decreased by 10.3% (p˂0.001) compared with the beginning of treatment. Comparative analysis of IА and IB group of patients showed a statistically significant difference in all parameters of the LPTEG at the level of p˂0.001.&#x0D; Conclusions. Treatment with anticoagulant drugs had a greater effect on the laboratory values ​​of external and general coagulation pathways parameters and almost did not affect the platelet-vascular hemostasis initial stage, internal coagulation pathway and fibrinolysis system. According to the LPTEG data, the hemostatic potential (HP) of patients in group IB was characterized by a statistically significant shift towards hypocogulation after the treatment. A detailed analysis of the LPTEG parameters of group IA patients showed a decrease in the aggregation activity of blood cells and normocoagulative HP.

Acute Coronary Syndrome with Normal or Near-Normal Coronary Angiography:Prevalence and Clinical Outcomes among Yemeni Patients

Abstract Background: Nonobstructive acute coronary syndrome or acute coronary syndrome with normal or near-normal coronary angiography (ACSNONCA) occurs in 10% to 25% of patients undergoing coronary angiography and in up to 6% of patients with troponin-positive ACS. Prevalence of ACSN-NOCA and its clinical outcomes were not discussed in previous studies in Yemen. Aim of Study: Our study aimed to compare demographic and clinical findings and prognosis in patients who have ACS with stenosis 50%) with 213 patients (27.6%). During the period January 2010 through September 2015, patients were admitted at Algamhoria Teaching Hospital, Aden and undergone cardiac catheterization in Cardiac Surgery Center at Althawra Hospital, Sana'a. Results: Group I Patients (stenosis <50%) were signifi-cantly younger were more likely to be female, younger, with fewer risk factors, compared to Group I Patients. We isolated and defined two subgroups within Group I: Group IA: Patients with normal angiograms (n=60, 52.6%) and Group IB patients with stenosis of 20-50% (n=54, 47.4%). Patients with stenosis of 20%-50% were relatively older males, with an increasing frequency of nondiabetic, with a history of chronic heavy chewing and with a worse prognosis, during long-term eval-uation. Follow-up data revealed that myocardial infarction was found in 1.8% of Group IA and in 5.2% of Group IB patients. Follow-up revealed no deaths in Group IA patients and two cardiac deaths (3.7%) in Group IB patients. Conclusions: Prognosis of patients with nonobstructive stenosis was significantly better than that of patients with critical obstructive stenosis. However, patients with stenosis of 20-50% had a worse prognosis than did those with normal coronary arteries.

Influence of the HLDF differentiation factor on the production of cytokines by bio-tissues of breast tissue in its non-malignant diseases and in invasive carcinoma of a non-specific type

We studied the effect of the HLDF differentiation factor on production of cytokines by biopsy samples of nonmalignant breast diseases (ND) and invasive breast carcinoma of no special type (IBC-NST), in the absence and presence of lymphogenic metastasis: IBC-NST patients werw subdivided into groups on the prognostic protocol of the 8th edition of the AJCC committee. Group IA consisted of patients with T1-T2 tumor sizes, and predominantly with positive expression of estrogen and progesterone receptors (ER+/PR+/HER2-); it also included one patient with the HER2+ (ER-/PR-/HER2+) molecular subtype. The IB group was mainly composed of patients with T2 tumor size, with the presence of lymphogenic metastasis (in 8 out of 10) patients and with positive expression of estrogen and progesterone receptors (ER+/PR+/HER2-) and it also included three patients with the HER2+ (ER-/PR-/HER2+) molecular subtype. Group IIA consisted of patients with T1-T2 tumor sizes, mainly with no metastases in the lymph nodes (in 11 out of 12 patients) and with a triple negative molecular subtype. Group IIB included patients with T2 tumor size, the presence of nodal metastasis and the expression of markers of ER-/PR-/HER2 - and ER-/PR-/HER2+. Group IIIA consisted of patients with tumor size T1-T3, with the presence of nodal metastasis and the expression of markers of ER-/PR+/HER2+ and ER-/PR-/HER2+. Group IIIC consisted of patients with T3 tumor size, lymphogenic metastasis, and expression of ER-/PR-/HER2-markers (triple negative molecular subtype). Due to a limited number of patients in the groups IIB, IIIA and IIIC, as well as due to more severe clinical and pathological stages, according to the prognostic Protocol of the 8th edition of the AJCC Committee, they were pooled into group III. Concentrations of IL-2, IL-4, IL-6, IL-8, IL-10, IL-17, IL-18, IL-1β, IL-1Ra, TNF-α, IFN-γ, G-CSF, GM-CSF, VEGF and MCP-1 were assayed in supernatants of biopsy specimens of breast tissue. Results have shown that with IBC-NST, a statistically significantly higher level of spontaneous production (SP) by biopsy specimens of IL-17, IL-18, IFN-γ and VEGF, and a lower level of SP IL-6 as compared with ND. Patients of all clinical and pathological groups showed a high VEGF spontaneous production as compared with ND, while statistically significant differences from patients with ND were not found in IL-17 spontaneous production in group IB patients, and IL-18 spontaneous production were absent in group IA. Only in patients with IA and IB, the IL-6 spontaneous production was lower as compared to ND, and the IL-8 spontaneous production was lower in the IA group. IFN-γ spontaneous production was higher in patients with IBC-NST group IIA as compared with ND. Under the influence of the HLDF differentiation factor, it was found that the parameters of IBC-NST patients were statistically significantly higher in the production of IL-1Ra, IL-17, IL-18 and VEGF, and statistically significantly lower in the production of IL-6 as compared to ND. HLDF had a higher impact on the content of IL-18 in IBC-NST patients than in ND. After HDLF sublimation IL-6 values were lower in patients of groups IA and IB, and HLDF-induced IL-17 production was higher only in patients of group IA. Statistically significant differences in the index of influence of HLDF (IVHLDF), representing ratio of the cytokine concentration in the supernatants of a biopsy specimen stimulated by HLDF to spontaneous cytokine production, were found between ND and IBC-NST in the case of on IFN-γ production, and also in the case of IL-4 production (between patients in the absence and presence of lymphogenic metastasis). IVHLDF for production of IL-6, IL-8 and TNF-α was lower in group IIA patients compared to group IA, and IVHLDF for production of GM-CSF and MCP-1 was lower in group IIA as compared to group III, in addition IVHLDF for MCP-1 products was lower in group IIA as compared to ND. The HLDF effect on the cytokine production by the tumor and its microenvironment was different in ND patients and IBC-NST patients. HDLF suppressed IFN-γ production in the pooled group of IBC-NST patients; HLDF mainly had a suppressive effect on the production of IL-6, IL-8, TNF-α, GM-CSF and MCP-1 in IBC-NST patients of group IIA.

Laparoskopik Kolesistektomi Sonrası Parasetamol ve İbuprofenin Postoperatif Analjezik Etkilerinin Karşılaştırılması

Objective: Non-steroid anti-inflammatory drugs (NSAIDs) and paracetamol (P) are frequent constituents of multimodal postoperative analgesia. The aim of this study was to compare analgesic effects of intravenous (IV) paracetamol and ibuprofen (IB) administered intraoperatively and in repeated doses postoperatively to the patients who underwent laparoscopic cholecystectomy. Material and Methods: A total of 40 patients with class of American Society of Anesthesiologists (ASA) I-III who underwent laparoscopic cholecystectomy were randomized into Groups-P and IB in this randomized, prospective and double-blind study. After anesthesia induction and initiation of the surgery, Group-P patients received 1 g IV paracetamol and Group-IB patients received 800 mg IV ibuprofen. At skin closure, 1.5 mg/kg of IV tramadol was administered. For postoperative analgesia, a patient-controlled analgesia (PCA) pump with tramadol was used. During the first 24h postoperatively, Group-P patients received 1 g of IV paracetamol and Group-IB patients received 400 mg of IV ibuprofen at every 6h. Patients with visual analog pain scale (VAS) scores ≥ 4 received rescue analgesia. The groups were compared for postoperative first 24h VAS scores, PCA demand, total tramadol dose, and rescue analgesic requirement. Results: Compared with Group-P, Group-IB had significantly lower VAS-awakening, VAS-post-anesthesia care unit (PACU) and VAS- 6th h scores. Postoperative rescue analgesic requirement was lower in Group-IB than in Group-P at all timepoints, most notably in the PACU. Conclusion: Compared with paracetamol, intraoperative and repeated postoperative doses of ibuprofen substantially decreased the pain scores and rescue analgesic requirement. As a component of multimodal analgesia, IV ibuprofen is an effective option for postoperative pain management.

Fibroscan for Assessment of Non Alcoholic Fatty Liver Disease in Type 2 Diabetic Patients in Tanta University Hospital

AbstractBackground: Fibroscan has recently been investigated as a new technique in the assessment of fibrosis of the liver in many diseases.Aim of Study: Was to evaluate the role of fibroscan in assessment of liver steatosis and fibrosis in patients with type 2 diabetes and NAFLD.Patients and Methods: The study population consisted of 40 patients with type 2 diabetes and 20 patients with obesity as controls. Patients with type 2 diabetes were divided into two groups: Group IA patients with type 2 diabetes and obesity and group IB patients with type 2 diabetes without obesity. Correlation between steatosis and fibrosis and disease was analyzed.Results: Steatosis of patients with type 2 diabetes was significantly higher compared to those of controls (p=0.042) further more patients with type 2 diabetes and obesity had higher level of steatosis than those without obesity. Also, patients with type 2 DM and obesity had higher levels of fibrosis than controls (p=0.023).Conclusion: Diabetic patients with insulin resistance (IR) and obesity have high prevalence of NAFLD and advanced liver fibrosis and we can use fibroscan for assessment of fibrosis and steatosis in those patients.

Neutrophil-to-lymphocyte ratio: relation to disease activity and carotid intima-media thickness in Beh\xe7et\u2019s disease

BackgroundBehçet’s disease (BD) is an autoinflammatory disorder. Disease activity could be detected by changes in peripheral blood cell components. The aim of this study was to assess the relationship between neutrophil-to-lymphocyte ratio (NLR) with disease activity and carotid intima-media thickness (cIMT) in patients with BD.Patients and methodsThis study was conducted on 20 adult patients with BD (group I). This group was subdivided according to cIMT into group Ia, which included patients with increased cIMT, and group Ib, which included patients with cIMT within normal ranges. Moreover, 20 age-matched and sex-matched apparently healthy volunteers were included as a control group (group II). Patients with BD were subjected to full history taking, thorough clinical examination, and assessment of disease activity according to Behçet’s Disease Current Activity Form score. The white blood cell count, neutrophil count, and lymphocytes count were recorded, and NLR was calculated. cIMT assessment was done for all participants.ResultsThere were statistically significant differences (P< 0.05) regarding lymphocytes count and NLR and highly statistically significant difference (P< 0.001) regarding neutrophil count, being higher in patients with BD. There was a statistically highly significant difference (P< 0.001) regarding cIMT, being higher in group Ia patients (0.82±0.03) than group Ib patients (0.50±0.04) and healthy control group (0.47 ±0.04). There was a statistically significance positive correlation (R=639, P=0.005) between NLR and Behçet’s Disease Current Activity Form score. In conclusion, higher NLR values were recorded in patients with BD. Furthermore, patients with active BD had higher NLR values than inactive, and NLR is higher in patients with increased cIMT; thus, NLR may be an important bio-index for detecting BD activity and the presence of vascular affection.

Spinal anaesthesia for spine surgery in prone position

Background . There is no universal approach to spinal anaesthesia (SA) in prone position according to type, dose and baricity of local anesthetic agent. Aim of the study is to compare isobaric and hyperbaric bupivacaine for SA for lumbar spine surgery. Methods .A total of 144 patients were divided into 3 groups (48 pts in each). In the group HB5 SA with heavy bupivacaine 0,5%-3,5 ml with exposure 5 min in supine position was performed. In the group HB10 SA with the same bupivacaine but with exposure 10 min was performed. In the group IB patients were anaesthetized with isobaric bupivacaine 0,5%-3,5 ml and than turned by themselves to prone position immediately after injection. We examined the level of sensory and motor block, and hemodynamics 15 min and 3 hrs after injection of bupivacaine. Results . The level of sensory block was higher in both hyperbaric groups compared to isobaric. Anywhere it was enough for surgery L3 and lower in all cases. Motor block was Bromage3 in all groups. After 3 hours, sensory level was the highest in the group HB5, and motor block was the highest in the group HB10. The most stable hemodynamics was in in group IB, and the most unstable in the group HB10. Conclusions . Isobaric bupivacaine is preferable for SA for lumbar spine surgery that lasts for 3 hrs and less due to stable hemodynamics and early start of surgery. For longer surgery hyperbaric bupivacaine may be recommended with exposure time in supine position for 5 min.

An Exhaustive Echocardiographic Analysis of Left Ventricular Structure and Functions in Children with Duchenne Muscular Dystrophy

Objectives: We aim to characterize cardiac morphological and functional changes by echocardiography that are present in the early and late stages of Duchhenne type muscular dystrophy (DMD). Methods: Sixty-two patients with DMD and 62 healthy children were included in the study. Study group was divided into patients with systolic dysfunction group Ia and those without systolic dysfunction group Ib. Transthoracic echocardiography was performed in all individuals in the study. Left ventricular end diastolic diameter (LVEDd), left ventricular end systolic diameter (LVSd), posterior wall thickness (LVPWd), interventricular septal thickness (IVSD), ejection fraction and fractional shortening (FS), LV mass index (LVmassi), early (E) and late (A) transmitral inflow velocities, the ratio of early-to-late peak velocities (E/A) were recorded. Tissue Doppler measurements of the peak early (E’) and late diastolic (A’) annular velocities, Doppler measurements of pressure half time (PHT) and mitral valve area were measured. Results: DMD patients had significantly higher LVmass, LVmass index and mitral valve area (P < 0.05). Patients showed significantly lower EF values (P < 0.001), SF (P < 0.001), stroke volume (P < 0.05), cardiac output (P < 0.05), Mitral valve PHT (P < 0.001), Mitral E’ (P < 0.001), Mitral A’ (P < 0.001), E’/A’ ratio (P < 0.001) than the control patients. Group Ia patients had higher age, LVH and LV mass index, LVEDd (P < 0.05), LVSd (P < 0.05), IVSd (P < 0.05) and LVPWd (P < 0.05) compared to group Ib patients (P < 0.05). There was a positive linear correlation between age and LVPWd (P < 0.001, r = 0.446). Conclusions: Our study showed that diastolic functions began to deteriorate in the early phase of DMD and systolic impairment begins subclinically in early stages.

MP40-17 PROSPECTIVE RANDOMIZED COMPARISON OF REPAIRING SIMPLE VESICOVAGINAL FISTULA WITH OR WITHOUT INTERPOSITION FLAP: A TERTIARY CARE HOSPITAL STUDY FROM NOTHERN INDIA

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy I1 Apr 2017MP40-17 PROSPECTIVE RANDOMIZED COMPARISON OF REPAIRING SIMPLE VESICOVAGINAL FISTULA WITH OR WITHOUT INTERPOSITION FLAP: A TERTIARY CARE HOSPITAL STUDY FROM NOTHERN INDIA Vishwajeet Singh, RahulJanak Sinha, Ankur Bansal, Seema Mehrotra, and Kawaljit Singh Vishwajeet SinghVishwajeet Singh More articles by this author , RahulJanak SinhaRahulJanak Sinha More articles by this author , Ankur BansalAnkur Bansal More articles by this author , Seema MehrotraSeema Mehrotra More articles by this author , and Kawaljit SinghKawaljit Singh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1264AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Outcome assessment of simple vesicovaginal fistula (VVF) repair with or without the use of interposition flaps. METHODS This prospective randomised study was conducted between 2012 to 2015 in department of Urology King George’s Medical University, Lucknow. Obstetric and gynaecologic fistula less than 4 cm were included. Those with complex or complicated fistula and fistula due to malignancy were excluded from this study. Patients were divided into two groups (group 1 and group 2) depending upon route of repair i.e. transvaginal or transabdominal respectively as per characteristics and location of fistula. These two groups were randomised into two subgroups (1A, 1B and 2A, 2B) based on with use and without use of interposition flap during fistula repair. Perioperative and post-operative parameters (blood loss, mean operating time, hospital stay, requirement of analgesics) were compared. All complications occurred in postoperative period till last follow –up were recorded and Clavien Dindo Classification was used to stratify them. RESULTS Fifty-four patients underwent transvaginal repair- group 1 (27 with Martius flap-group 1A and 27 with no Martius flap – group 1B). Sixty-six patients underwent transabdominal repair-group 2 (33 with interposition flap- group 2A and 33 with no flap – group 2B). Blood loss, mean operating time, hospital stay, requirement of analgesics were comparable between sub-group 1A versus 1B; and 2A versus 2B. Overall success rate of repair across all groups was 92.7% (115/124). Success rate was 88.9% in transvaginal repair with martius flap versus 92.6 % in transvaginal repair with no flap (P=1.0) and it was 93.9 % in both subgroups of transabdominal repair (P=1.0). Mean follow up period was 33.6 months (range 12-46). 9 out of 27 patients (33.3%) with Martius flap interposition had significantly reduced sensation on labia majora. Of these 9 patients, 5 cases reported numbness and 4 had pain compared to patients in group IB who did not report any altered sensation in labia. (P = 0.001). CONCLUSIONS The success rates are similar in simple VVF repair irrespective of the use of interposition flaps. However, overall morbidity following repair with interposition flap is more when compared with repair without interposition flap either by transvaginal or by transabdominal route. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e529 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Vishwajeet Singh More articles by this author RahulJanak Sinha More articles by this author Ankur Bansal More articles by this author Seema Mehrotra More articles by this author Kawaljit Singh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Quantitative evaluation of masseter muscle stiffness in patients with temporomandibular disorders using shear wave elastography

PurposeThe aim of this study was to quantify masseter muscle stiffness in patients with masticatory myofascial pain. MethodsStiffness was measured using shear wave elastography, which expresses stiffness as shear wave velocity (Vs). A phantom study was conducted to confirm the reliability of the measuring device. The study participants were 26 females with bilateral masseter muscle pain who were classified into either Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) group Ia (myofascial pain; n=13) or RDC/TMD group Ib (myofascial pain with limited opening; n=13). Healthy controls consisted of 24 female volunteers with normal teeth and jaws, who were not classified into groups I/II/III by RDC/TMD. ResultsMuscle stiffness was 1.96m/s (12.5kPa) in 13 patients in group Ia, 2.00m/s (13.0kPa) in 13 patients in group Ib and 1.27m/s (5.25kPa) in 24 control subjects. Vs was significantly greater in groups Ia and Ib than in the control group (p<0.05). Characteristic pain intensity (CPI) became clear as an independent factor impacting Vs (partial regression coefficient=0.714; multiple regression analysis , p<0.05). Masseter muscle stiffness was positively correlated with CPI (p< 0.05) and negatively correlated with maximum assisted mouth opening (p<0.05) and painless mouth opening (p<0.05). ConclusionShear wave elastography is useful to quantify masticatory muscle stiffness. Masseter muscle stiffness of females measured using shear wave elastography was about two-fold greater in group Ia and Ib than in the healthy control group.

Safety and Risk of Superselective Transcatheter Arterial Embolization for Acute Lower Gastrointestinal Hemorrhage with N-Butyl Cyanoacrylate: Angiographic and Colonoscopic Evaluation

PurposeTo retrospectively evaluate the safety and risk of transcatheter arterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) for urgent acute arterial bleeding control in the lower gastrointestinal tract by angiography and colonoscopy. Materials and MethodsNBCA TAE was performed in 16 patients (mean age, 63.7 y) with lower gastrointestinal bleeding (diverticular hemorrhage, tumor bleeding, and intestinal tuberculosis). Angiographic evaluation was performed by counting the vasa recta filled with casts of NBCA and ethiodized oil (Lipiodol) after TAE. Patients were classified as follows: group Ia, with a single vas rectum with embolization of 1 branch (n = 6); group Ib, with a single vas rectum with embolization of ≥ 2 branches (n = 8); group II, with embolization of multiple vasa recta (n = 2). All patients underwent colonoscopy within 1 month, and ischemic complications (ulcer, scar, mucosal swelling, fibrinopurulent debris, and necrosis) were evaluated. ResultsThe procedure was successful in all patients. No ischemic change was observed in any patients in group Ia and in two patients in group Ib. Ischemic changes were observed in six group Ib patients and both group II patients. Group Ib patients experienced ischemic complications that improved without treatment. One patient in group II underwent resection for intestinal perforation after embolization of three vasa recta. One patient in group II with sigmoid stricture with embolization of six vasa recta required prolonged hospitalization. ConclusionsNBCA embolization of ≥ 3 vasa recta can induce ischemic bowel damage requiring treatment. NBCA TAE of one vas rectum with ≥ 2 branches could also induce ischemic complications. However, these were silent and self-limited.

Impaired selective cytokine production by CD4+ T cells in Common Variable Immunodeficiency associated with the absence of memory B cells

Common Variable Immunodeficiency (CVID) is a primary immunodeficiency characterized by B cell dysfunction and decreased serum immunoglobulin. CVID patients are classified by the absence or presence of memory B cells. In addition, T cell defects have been demonstrated in only a proportion of CVID patients. The aim of this study was to evaluate the function of CD4+ T cells from CVID patients and its association with memory B cells. Patients were classified according to their Freiburg groups: group Ia and Ib, with decreased switched memory B cells (<0.4 of PBL), and group II, with normal B cell subsets. Their T cell function was evaluated after stimulation. We observed normal and even increased CD4+ T cell proliferation in group Ia (p=0.0277). The proliferation positively correlated with the clinical severity score (r=0.4796). We observed lower levels of IL-17A and IL-10 in group Ia (p=0.0177, 0.0109) and Ib (p=0.0009, 0.0084) patients. Group Ib patients also had low levels of IL-13 and IL-9 (p=0.0169, 0.010). Group II patients had similar cytokine production to that of the controls. BAFFR expression was reduced in groups Ia (p=0.0001) and Ib (p=0.0002) and showed an inverse correlation with the severity score (p=0.0262; r=0.5371). ICOS expression was reduced in group Ia (p=0.0364), and PD-1 was increased in group Ib (p=0.0432) patients. This study shows a selective impairment in cytokine production in group Ia patients, which was more extensive than in group Ib patients. The impairment was associated with BAFFR expression in B cells, with ICOS and PD-1 in T cells and, remarkably, with the absence of memory B cells and with the disease severity. Our results suggest that the evaluation of cytokine expression by T cells in combination with the study of B cell memory could be important for understand the pathogenesis of CVID patients.

High mortality and poor morbidity after hip fracture in patients with previous vertebral fractures.

Although vertebral fracture in patients is a predictor of subsequent hip fracture, no study has assessed the mortality and functional outcome in hip fracture patients with previous vertebral fracture. Between September 2009 and December 2012, we evaluated 246 patients over 50-years-of-age diagnosed with femoral neck or intertrochanteric fractures who underwent surgery. The patients were categorized into two groups and two subgroups. Group Ia comprised 150 patients with previous vertebral fracture at the time of hip fracture. Group Ib comprised 96 patients with no vertebral fracture. Group IIa consisted of 76 patients <80-years-of-age with previous vertebral fracture. Group IIb comprised 69 patients <80-years-of-age without previous vertebral fracture. The mortality rate and functional outcome of osteoporotic hip fracture patients with and without vertebral fractures were compared. The cumulative mortality rate at 6 and 12months post-fracture was 19 and 23% in Group Ia and 6 and 7% in Group Ib, respectively. In subgroup analysis, the cumulative mortality rate at 6 and 12months was 13 and 17% in Group IIa and 3 and 4% in Group IIb, respectively. Shut-in patients at the final follow-up included 51 of 103 (49.5%) patients in Group Ia and 19 of 83 (22.9%) patients in Group Ib. In subgroup analysis, the shut-in patients included 18 of 58 (31.0%) patients in Group IIa and 10 of 62 (16.1%) patients in Group IIb. Previous vertebral fracture was associated with a poor functional outcome and increased mortality in patients with hip fracture.

AB0528 Study of Serum Anti-Nucleosomal Antibodies as Marker of Renal Affection in SLE Patients

BackgroundRenal biopsy is the gold standard for providing information about the histological classes of lupus nephritis and the degree of activity and chronicity in the glomeruli. Novel biomarkers are able...

Effect of thrombolytic therapy on ventricular function of patients with acute myocardial infarction: a single institutional experience in Iraq

Background and objective: Early reperfusion has been shown to improve left ventricular function (LVF) and survival after acute myocardial infarction (AMI). We aimed to evaluate the influence of thrombolytic therapy (TT) on LVF in patients with AMI. Methods: This study involved 100 patients who were diagnosed with acute ST-segment elevation myocardial infarction (STEMI). Patients were allocated into 2 groups; group I (n=50 patients) who received intravenous TT, and this was further subdivided equally into groups Ia and Ib; and group II (n=50), who did not receive TT. An echocardiographic-derived measurement of LVF at the end of the first and 6th weeks of the event was assessed. A left ventricular ejection fraction of ≥ 55% was considered a normal systolic function. Results: After adjusting for age and gender, approximately 85% of group Ia patients and 50% of group Ib patients demonstrated an EF of ≥ 55% while only 16% of patients in group II had an EF of ≥55%, regardless of the infarcted area/site. Conclusion: Thrombolytic therapy significantly improved LVF in patients with STEMI when it was administered within 12 hours of symptoms onset, than in those who did not receive this form of therapy.&nbsp

Carvedilol Enhances the Antioxidant Effect of Vitamins E and C in Chronic Chagas Heart Disease

BackgroundChagas disease is still an important endemic disease in Brazil, and the cardiac involvement is its more severe manifestation. ObjectiveTo verify whether the concomitant use of carvedilol will enhance the antioxidant effect of vitamins E and C in reducing the systemic oxidative stress in chronic Chagas heart disease. MethodsA total of 42 patients with Chagas heart disease were studied. They were divided into four groups according to the modified Los Andes classification: 10 patients in group IA (normal electrocardiogram and echocardiogram; no cardiac involvement); 20 patients in group IB (normal electrocardiogram and abnormal echocardiogram; mild cardiac involvement); eight patients in group II (abnormal electrocardiogram and echocardiogram; no heart failure; moderate cardiac involvement); and four patients in group III (abnormal electrocardiogram and echocardiogram with heart failure; severe cardiac involvement). Blood levels of markers of oxidative stress were determined before and after a six-month period of treatment with carvedilol, and six months after combined therapy of carvedilol with vitamins E and C. The markers analyzed were as follows: activities of superoxide dismutase, catalase, glutathione peroxidase, glutathione S-transferase and reductase, myeloperoxidade and adenosine deaminase; and the levels of reduced glutathione, thiobarbituric-acid reactive substances, protein carbonyls, vitamin E, and nitric oxide. ResultsAfter treatment with carvedilol, all groups showed significant decrease in protein carbonyls and reduced glutathione levels, whereas nitric oxide levels and adenosine activity increased significantly only in the less severely affected group (IA). In addition, the activity of most of the antioxidant enzymes was decreased in the less severely affected groups (IA and IB). By combining the vitamins with carvedilol, a reduction in protein damage, in glutathione levels, and in the activity of most of the antioxidant enzymes were observed. ConclusionsThe decrease in oxidative stress levels observed by means of the markers tested was more significant when carvedilol was used in combination with the antioxidant vitamins. The findings suggest that both carvedilol alone and in combination with the vitamins were effective in attenuating the systemic oxidative stress in patients with Chagas heart disease, especially those less severely affected, thus suggesting the possibility of synergism between these compounds.

Role of apparent diffusion coefficient values for the differentiation of viable and necrotic areas of breast cancer and its potential utility to guide voxel positioning for MRS in the absence of dynamic contrast-enhanced MRI data

We carried out retrospective analysis of apparent diffusion coefficient (ADC) values in 48 infiltrating ductal breast cancer patients who had dynamic contrast-enhanced magnetic resonance imaging (DCEMRI; Group I) and in 53 patients (Group II) for whom DCEMRI data were not available. Twenty-three patients of Group I showed no necrosis (Group Ia), while in 25 patients, both viable (nonnecrotic) and necrotic tumor areas (Group Ib) were observed on DCEMRI. T1-weighted, fat-suppressed and short inversion recovery images were used to identify the viable and necrotic tumor areas in Group II patients, and necrosis was not seen in 11 patients (Group IIa), while 42 (Group IIb) showed both viable and necrotic tumor areas. The ADCs of the necrotic area of Group Ib (1.79±0.30 ×10−3 mm2/s) and Group IIb (1.83±0.40 ×10−3 mm2/s) patients were similar and significantly higher (P<.01) compared to the ADCs of the viable tumor area of Group Ia (0.96±0.21 ×10−3 mm2/s) and Group IIa (0.90±0.17 ×10−3 mm2/s) patients. Proton MR spectroscopy (MRS) data were also available in these patients, and the ADC values were retrospectively determined from the voxel from which MR spectrum was obtained. These values were compared with the ADC obtained for the viable and necrotic areas of the tumor. ADC of the MRS voxel was similar to that obtained for the viable tumor area in patients of both groups. This interesting observation reveals the potential utility of using ADC values to identify viable tumor area for positioning of voxel for MRS in the absence of DCEMRI data.