Fusiform “True” Posterior Communicating Artery Aneurysm with Basilar Artery Occlusion: A Case Report / 신경중재치료의학

Isolated posterior communicating artery (PCoA) aneurysms are rare, predominantly fusiform in morphology, and rarely present with subarachnoid hemorrhage. Endovascular management of this pathology is technically challenging due to extreme tortuosity, the artery course in the subarachnoid space, sharp angulations at PCoA junctions with the parent artery, and, at times, associations with either internal carotid artery or basilar artery occlusions. We present a case of a ruptured fusiform PCoA at the junction of middle and distal third with concomitant proximal basilar artery occlusion. The PCoA reforms the posterior circulation, making it a vital artery. Stent-assisted coiling was performed with extreme difficulty in achieving distal positioning of the stents in the basilar artery/posterior cerebral artery/distal PCoA due to artery tortuosity. There was technical difficulty in the stent deployment. After changing strategies to a larger diameter laser-cut stent, endovascular treatment could be performed. There were good angiographic and clinical outcomes with stable occlusion at 6-month-follow-up.

Video Call-based Fitness Assessment shows Poor Fitness in People with Type II Diabetes: Findings from Diabefly Digital Therapeutics Program

Aim: To study the efficacy of uptitrating the dose of Teneligliptin from 20 to 40 mg in patients with type II diabetes mellitus. Method: A retrospective, comparative analysis was undertaken in 853 type II diabetes mellitus patients (499 males and 354 females) who had follow-up records for more than 6 months. These patients were uncontrolled after use of atleast three oral antidiabetic drugs (OADs) and Teneligliptin 20 mg was added as the fourth drug. Patients who remained uncontrolled with the addition of 20 mg of Teneligliptin at the end of 3 months and were switched to receive 40 mg of Teneligliptin daily were included in this study. Results were analyzed at 3 and 6 months to ascertain efficacy of high-dose (40 mg) Teneligliptin. All other OADs remained the same in both groups. In all patients, the fasting blood glucose, postprandial blood glucose, and hemoglobin A1c (HbA1C) were evaluated and compared. Result: A total of 853 patients whose dose of Teneligliptin was increased from 20 to 40 mg were included in the study. At the end of 3 months after using Teneligliptin 40 mg, mean reduction in HbA1C was 0.5% (p-value 0.154). Similarly, mean reduction in fasting blood sugar (FBS) and postprandial blood sugar (PPBS) was 6.5 and 3.6 mg/dL, respectively (p-value 0.234 and 0.143). At the end of 6 months after using Teneligliptin 40 mg HbA1C showed no change but mean FBS and PPBS showed a modest reduction of 14.6 and 14 mg/dL, respectively (p-value < 0.001). Conclusion: The results of our study show that there was no statistically significant improvement in glycemic parameters when dose of Teneligliptin was increased from 20 to 40 mg at 3 months. But at 6 months, the FBS and PPBS showed a modest reduction of 14.6 and 14 mg/dL, respectively (p-value < 0.001) but the HbA1C showed no change

Incidence of Olfactory and Gustatory Dysfunctions in the Early Stages of COVID-19: An Objective Evaluation

Abstract Introduction Coronavirus disease 2019 (COVID-19) is a dangerous infectious disease caused by a newly discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has various clinical presentations. Numerable cases with non-specific olfactory and gustatory dysfunctions in COVID-19 have been reported from all over the globe. This is important as awareness will let people to self-isolate and help in limiting disease spread. Objective To objectively evaluate the frequency of olfactory and gustatory dysfunction, which may occur independently or with other symptoms, in laboratory confirmed COVID-19 patients at an early stage of the disease. Methods Objective evaluation of olfactory and gustatory function of 322 COVID-19 patients treated at our hospital, (SMGS, Government Medical College, Jammu), from August 2020 until November 2020. Results Our study population included 127 (39.4%) males and 195 (60.6%) females. Two hundred and twenty-six (70.2%) COVID-19 patients experienced olfactory and gustatory disorders. One hundred and sixty-five (51.2%) cases experienced both olfactory and gustatory disorders. Isolated olfactory dysfunction was reported in 34 (10.6%) patients, while 27 (8.4%) patients experienced only gustatory dysfunction. Conclusion The olfactory and gustatory dysfunctions, without any nasal obstruction or rhinorrhea, are significant symptoms in the clinical presentation of early COVID-19 patients. This presentation can be recognized at the earliest one, and it can reduce the high communicability of the COVID-19 disease.

MUCORMYCOSIS- A CHALLENGE TO DIAGNOSE

Mucormycosis, an angioinvasive fungal infection of the order Mucorales became very common due to COVID-19 pandemic situation in maxillofacial clinic still remained much undiagnosed disease due to patient’s other complaints and lack of history given.We shall be discussing about such case in this paper.

Estimation of prostate size by trans-rectal ultrasound and its correlation with DRE and endoscopic grading

Aim: Digital rectal examination (DRE) grading and the grade of prostatomegaly on cystoscopy are routinely used in clinical practice, but its correlation to prostate volume is understudied. This study was done to assess the correlation of DRE and endoscopic grading with the prostate volume on trans-rectal ultrasound (TRUS). Materials and Methods: This study was carried out in 101 eligible patients with prostatomegaly. Each patient was evaluated for three parameters, prostate volume by TRUS examination, DRE and endoscopic grading on cystoscopy. Pearson correlation coefficient was calculated to find the correlation between variables, p<0.05 was taken to be statistically significant. Data were analyzed using the Epi Info (TM) 7.2.2.2. Results: Significant positive correlation (p<0.001) was found between TRUS Volume and DRE grading (Pearson Correlation=0.945) and TRUS volume and Endoscopic grading (Pearson Correlation=0.949). Both the grading were also significantly positively correlated (Pearson Correlation=0.989, p<0.001). Conclusion: Our attempt for correlating the digital rectal grading and endoscopic grading with prostate volume is satisfactorily validated in the clinical setting. These grades are sufficient to provide a rough estimation of the prostate volume and to classify patients with prostatomegaly.

Mortality in Cervical Spine Injury: A Study in a Tertiary Health Care Center in India

Introduction: Cervical spine injury is a common injury worldwide. When cervical cord is also affected, it is the most devastatinginjuries due to poor recovery and disabling consequences. The management is still in the process of continuous evolution. However,even after so much ongoing research, there is no satisfactory treatment which can give complete restoration of the function.Materials and Methods: The study was carried out as an observational study and had both prospective and retrospectivecomponents. The patient with cervical spine quadriplegia coming to the Department of Orthopedics as well as the bodies of thedeceased with quadriplegia at the Department of Jurisprudence, Sir Sunderlal Hospital, Institute of Medical Sciences, BanarasHindu University, over a period of 2 years from June 2005 to June 2007 were included in the study.Results: A total of 92 patients of traumatic quadriplegia were admitted in orthopedics ward from May 2005 to June 2007. Ofthis, 44 patients expired either during the hospital stay or during follow-up period, a maximum of 6 months. The results arewell depicted in tables.Conclusion: There must be a training of primary health center staffs regarding the role of cervical immobilization duringtransportation to a hospital and also for rapid transportation of a cervical spine injury patient to a respective well-equippedhospital. The trained nursing staffs and a team approach along with well-equipped intensive care unit must be constituted forthe management of traumatic quadriplegia patients.

A qualitative study on the perceptions of patients with vesicovaginal fistula

Background: Vesicovaginal fistula (VVF) is a grave complication of gynecological surgeries and vaginal deliveries, leading to physical, psychological, and social implications. In India, due to the high patient turnover, it is not uncommon to find such patients in every region. While various works elaborate the surgical aspect of VVF, there is a dearth of literature on qualitative research. Objective: This study was done to better understand the impact of physical, psychological, and social factors on the lives of patient with VVF. Materials and Methods: This study was conducted in the department of urology at a tertiary care hospital. It was a descriptive qualitative study that involved audio recorded in-depth interviews of 18 such patients followed by their transcription and qualitative data analysis. Results: We identified five major categories from the transcripts, namely, understanding of the disease, initial reaction of the patient, reaction of the husband and family, personal and physical discomfort, and social implications. While majority of the perceptions were also reported in the previous studies, we found some unique perceptions in the form of false perception of urine leak from urethra in spite of vagina and blaming, the birth of female child for bad luck was found in our study. Another favorable unique response not noted in other studies was excellent family support in half of the patients. Conclusion: Our study supports the idea that VVF has far deeper implications other than physical discomfort. This study promotes wholesome management of patients, family, and society using a multidisciplinary approach.

Effects of curcumin on cardiovascular risk factors in obese and overweight adolescent girls: a randomized clinical trial

ABSTRACT BACKGROUND: Obese adolescents are at higher risk of development of cardiovascular risk factors and obesity in later life. Dietary intake of antioxidants, particularly curcumin, as an active ingredient of turmeric extract, may have noticeable effects on obesity and its important complications such as cardiovascular risk factors. Therefore, the aim of this study was to assess the effects of curcumin supplementation on cardiovascular risk factors among overweight and obese female adolescents. DESIGN AND SETTING: Randomized placebo-controlled clinical trial; Pediatric Cardiovascular Research Center, Isfahan, Iran. METHODS: 60 adolescent girls (aged 13-18 years) were randomly assigned to receive either placebo or intervention. The adolescents were asked to consume one 500 mg tablet per day, containing either standardized 95% turmeric extract or placebo, and to undergo a weight maintenance or a mild weight loss diet for 10 weeks. Anthropometric and biochemical indices were assessed at the baseline and the end of the intervention. RESULTS: Curcumin supplementation had beneficial effects on body mass index (P = 0.019), waist circumference (P = 0.008), hip circumference (P = 0.030), high-density lipoprotein levels (P = 0.042) and triglyceride/high-density lipoprotein ratio (P = 0.021). However, in univariate analysis of covariance, no significant differences were found between the intervention and placebo groups after 10 weeks of supplementation (P > 0.05). CONCLUSIONS: Prescription of curcumin supplementation along with use of a slight weight loss diet might have beneficial effects on some cardiovascular risk factors among overweight and obese female adolescents. Larger clinical trials with higher curcumin doses and longer duration are needed to confirm the results from the current study. CLINICAL TRIAL REGISTRATION: IRCT20171107037302N1

Comparative assessment of chronological, dental, and skeletal age in children

Background: Age of a child can be assessed from various parameters such as chronological age, height, weight, secondary sexual characteristics, skeletal age, or dental age. The present study was planned to assess and compare chronological age with dental age (Demirjian's method and Willem's method) and skeletal age (Fishman's method). Materials and Methods: The present study was done on a sample of 100 children in the age group of 9–14 years. The chronological age was computed through the birth certificates and dental age was calculated from their orthopantomograms (OPGs) using Demirjian's and Willem's methods. Hand-wrist radiograph of the left hand was used to compute skeletal age using Fishman's method. Paired t-test and Pearson's correlation coefficients were calculated as a part of statistical analysis at a significance level of P < 0.01. Results: The mean chronological age among the group was 12.37 ± 1.34 years, the mean dental age by Demirjian's method was 12.36 ± 1.72 years, the mean dental age by Willem's method was 12.36 ± 1.51, and the mean skeletal age by Fishman's method was 13.03 ± 1.34 years. Out of the all methods evaluated in the study, Fishman's method of age estimation showed the least value of correlation coefficient (r = 0.728) with the chronological age, whereas Willem's method showed the maximum correlation with the chronological age (r = 0.885). Conclusion: It can be concluded from the present study that the dental age estimation evaluated by the digital OPG by both the methods, that is, Demirjian's method and Willem's method, has shown high accuracy when applied to the children of Faridabad. Skeletal maturation evaluated by Fishman's method using hand-wrist radiographs was found to overestimate the age when compared to chronological age in both the sexes.

Management of Fracture Distal Femur Using Retrograde Supracondylar Nail: A Prospective Analysis at a Tertiary Care Centre

Background: In the past two decades, the open reduction andinternal fixation has gained good result in the management ofdistal femur fractures. The present study has been undertakento evaluate the overall functional outcome of patients treatedby supracondylar nail.Materials and Methods: The present study was conducted atDepartment of Orthopaedics, Teerthanker Mahaveer MedicalCollege and Research Centre, Moradabad, UP, India. All thepatients admitted in the department of Orthopaedics withfracture distal femur and managed by intramedullarysupracondylar nail were included. Final assessment of resultswas done based on modified Mehrotra's grading based on theassessment of the final functional results and also taking intoconsideration, the complications if any.Results: Average duration between injury and surgery was3.38 days. In only 8% of the cases open reduction by additionalparapatellar incision was required. Average duration of surgerywas 52.6 minutes. Most common complication we encounteredwas knee stiffness in 16 cases followed by local symptom atdistal screw site in 12 cases. Superficial infection was seen in 9& deep infection in 2 cases. In 2 cases shortening was morethan 2.5 cm. Average range of movement at the knee joint inour series was 110.93 with 40 cases having full range ofmovement. Final results were excellent in 61 of the cases.Good in 23% Fair in 11%, Poor in 5%.Conclusion: Finally we conclude that intramedullarysupracondylar nail should be the treatment of choice for distalfemoral fractures. As it has all the advantages of closedtreatment like minimal blood loss, less soft tissue stripping,preservation of fracture haematoma and minimalcomplications. This operation is particularly suited for Type A,C1 & C2 types of fractures as shown by the final functionalresults of this study.