Endothelial markers in high altitude induced systemic hypertension (HASH) at moderate high altitude

BackgroundChronic intermittent hypoxia is known to induce systemic arterial hypertension whereas chronic hypoxia causes pulmonary arterial hypertension. High altitude (HA) induced systemic hypertension (HASH) in previously normotensive lowlanders following acclimatisation and prolonged stay at moderate HA is a commonly encountered medical problem. HASH has been attributed to increased sympathetic discharge. Endothelial dysfunction (ED) is implicated in hypertension in the plains hence this study was conducted in HA. This is relevant especially because of the established role of ED in the aetiopathogenesis of HA illnesses. Since hypoxia may induce ED, we aimed at studying the association of endothelial dysfunction with HASH in temporary residents at HA.MethodsIn this case–control single-centre study, we evaluated ED, by measuring endothelial molecular markers, soluble intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (VCAM-1), vascular endothelial growth factor (VEGF) and endothelial selectin (E-Selectin) in 24 cases with HASH and 25 age, sex matched normotensive controls at moderate high altitude (11,500 ft).ResultsThe levels of sICAM-1 (patients: 214.3 ± 34.2 μg/L, controls: 196.2 ± 28.5 μg/L; p = 0.049) and VCAM-1 (patients 766.1 ± 123.4 ng/mL, controls: 668.6 + 117.6 ng/mL; p = 0.007) were statistically higher in the patient group. However, VEGF and E-Selectin were not significantly different between the groups. sICAM-1 significantly correlated with levels of systolic and diastolic blood pressure (r = 0.401, p = 0.003 and 0.486, p = 0.000) respectively.ConclusionHASH is associated with endothelial dysfunction in form of raised levels of sICAM-1 and VCAM-1.     

A cross-sectional study of liver function tests in HIV-infected persons in Western India

BackgroundDerangement of liver function tests (LFTs) is common in people living with human immunodeficiency virus/acquired immune deficiency syndrome (PLHA). The cause is multifactorial. Drug-induced liver injury (DILI) is the commonest cause and others being alcohol abuse and concomitant viral hepatitis. The aim of the research was to study the prevalence of LFT abnormalities in PLHA.MethodsThe study was carried out in a tertiary care hospital. Evaluation included a detailed history, thorough clinical examination and investigations including a haemogram, serum biochemistry, serology for hepatitis, and CD4 cell count.ResultsA total of 247 patients were evaluated. Of these, 212 (85.82%) were on antiretroviral therapy (ART), 111 (44.93%) were on anti-tubercular therapy (ATT), and 94 (38.05%) were on concurrent ATT–ART.Abnormal LFTs were seen in 128/247 (51.82%) PLHA. In the majority (88.28%), the LFT abnormalities were mild. LFT abnormalities were seen in 109/212 (51.4%) patients on ART, in 56/111 (50.5%) patients on ATT, 46/94 (48.93%) patients on concurrent ART–ATT. There was no difference in LFT abnormalities among the three groups nor was there any significant association with alcohol consumption. There was a statistically significant co-relation between albumin/globulin ratio and CD4 count (p = 0.0002). Counter-intuitively, LFT abnormalities were commoner in patients not receiving nevirapine (p = 0.043), but severe abnormalities (grade III/grade IV) were commoner in those receiving nevirapine (p = 0.005) and in those on concurrent ART–ATT (p = 0.008).ConclusionLFT abnormalities in PLHA are common; but usually mild. There is a strong association between severe abnormalities and nevirapine-based therapy (p = 0.02) and concurrent ATT–ART (p = 0.008).     

Emotional and behavioral disturbances in school going HIV positive children attending HIV clinic

BackgroundTo study the emotional and behavioral disturbances (EBD) in school going HIV positive children attending HIV center in a tertiary care hospital.MethodThis cross-sectional study was conducted on 258 HIV infected children between 6 and 16 years of age, 200 were on Anti-retroviral therapy (ART) and 58 were not on ART. They were evaluated for EBD by using Pictorial Pediatric Symptom Checklist (PPSC) screening tool. A cut-off score of 28 was taken as significant for detecting early EBD.ResultsThe prevalence of EBD in our study is 11.2%. Demographic and disease related profile were assessed for correlation with EBD. Type of family (p = 0.023), school attendance (p = 0.034), school performance (p = 0.045), and CD4 count (p = 0.015) were detected to have significant association with early manifestation of EBD in the study group.ConclusionsHIV positive children who have low CD4 count, poor school attendance, and performance are at a higher risk of being detected with EBD. Screening with PPSC to identify EBD in HIV positive children attending HIV clinic in a hospital setting could help in early diagnosis and management.     

A clinical correlation of conjunctival microangiopathy with grades of retinopathy in type 2 diabetes mellitus

BackgroundConjunctival microangiopathy has been described among diabetics similar to retinal vessel angiopathy. Correlation of these conjunctival microangiopathy changes with retinopathy may form the basis of screening by external examination without expert fundus evaluation.MethodsConjunctival vessels widths and tortuous segment length of conjunctival vessels of 96 patients with type 2 diabetes mellitus were photographed and measured by the Zeiss Fundus camera Visupac software. The measurements were correlated with retinopathy grade in those eyes.ResultsThe mean conjunctival vessel width was 40.61 μ (SD 17.25) with a uniform increase from 34.4 μ (SD 8.70) in mild NPDR to 53.50 μ (SD 33.45) in the PDR group which was statistically significant (p < 0.01). The tortuous conjunctival vessel segment length increased from 711.51 μ (SD 83.90) in the mild NPDR group to 921.94 μ (SD 129.26) in those with PDR (p < 0.01). Vessel width greater than 80 μ was seen only in PDR and tortuosity values greater than 900 μ were seen in severe grades (severe NPDR and PDR). Both conjunctival vessel width and tortuosity showed a positive statistical correlation with increasing severity of retinopathy (r = 0.386, r² = 0.149 and r = 0.645, r² = 0.415).ConclusionA positive correlation was seen between conjunctival vessel width and tortuosity with severity of retinopathy. Widths over 80 μ and tortuous segment length over 900 μ are suggestive of severe grades of retinopathy.     

Antitubercular therapy induced liver function tests abnormalities in human immunodeficiency virus infected individuals

BackgroundBoth antitubercular therapy (ATT) and antiretroviral therapy (ART) can cause drug induced liver injury (DILI) in tuberculosis (TB) and human immunodeficiency virus (HIV) coinfection. The aim of this research was to study ATT-induced liver function test (LFT) abnormalities in HIV-infected patients.MethodsHIV-infected patients diagnosed with TB were evaluated with baseline LFT and CD4 counts. ATT regimen was modified if baseline LFT was significantly abnormal. Patients on protease inhibitors were given rifabutin instead of rifampicin. In patients on nevirapine-based ART, efavirenz was substituted for nevirapine. In ART-naive patients, the timing of introduction of ART was according to CD4 cell counts. LFT were repeated fortnightly or as clinically indicated for 10 weeks.ResultsWe studied 100 patients with HIV ([M – 67, F – 23], mean age: 40.05 ± 10.75 years, mean CD4 cell count: 239.157 ± 228.49 cells/dL). Sixty-one patients were on ART prior to diagnosis of TB. Baseline LFT abnormalities (n = 40) were similar in ART and non-ART group (28/61 vs 12/39, p = 0.13). After starting ATT, derangement of LFT was observed in majority of patients (99/100). However, liver sparing ATT was required only in 15 patients. Bilirubin >2.5 mg/dL was seen only in 9 patients. Significant rise in transaminases was commoner in patients on concurrent ART and ATT (p = 0.044) and with baseline LFT abnormalities (p = 0.00016). There was no case of acute liver failure or mortality.ConclusionMild LFT abnormalities are common in HIV-infected individuals on ATT. Concomitant use of ATT and ART and baseline LFT abnormalities increase the risk of significant DILI. However, with closer follow-up, serious liver injury can be prevented.     

The risk of thyroid carcinoma in multinodular goiter compared to solitary thyroid nodules: A retrospective analysis of 600 patients

BackgroundIt is generally believed that multinodular goiter (MNG) is associated with a lower risk of malignancy compared to solitary thyroid nodules (STN). This will be the null hypothesis in this retrospective study and we aim to prove or reject it.MethodsMedical files and histopathology reports of 600 patients who underwent thyroidectomy over 4-year period were reviewed. Data including patient’ age, gender, presentation, ultrasonography, FNAC, surgical procedures, final histopathologic diagnosis and stage of malignant tumors were collected and analyzed. The primary end point was assessment of risk of thyroid carcinoma in patients with MNG compared to those with STN. Secondary endpoints included demographic differences and prognosis.ResultsThere were 459 females (76.5%). Mean age was 44.3 ± 14.5 years (range 14–85). After exclusion of 33 patients, 224 (39.5%) had STN and 343 (60.5%) had MNG. The prevalence of thyroid cancer was 41.1% (92/224) in STN compared to 29.2% (100/343) in MNG (Chi-Square = 8.593, p < 0.01). However, on multiple logistic regression analysis this correlation was found insignificant (p = 0.640). Only male gender (p = <0.000005) and preoperative impression of malignancy (p = 0.000082) were significantly associated with thyroid carcinoma.ConclusionThe risk of thyroid carcinoma in STN and MNG was similar. Male gender was identified as a risk factor for thyroid cancer while age, number and size of nodules were not.     

Automated e-mail messaging as a tool for improving quit rates in an internet smoking cessation intervention

ObjectiveThe aim of this study was to determine whether an automated e-mail messaging system that sent individually timed educational messages (ITEMs) increased the effectiveness of an Internet smoking cessation intervention.DesignUsing two consecutive series of participants, the authors compared two Web-based self-help style smoking cessation interventions: a single-point-in-time educational intervention and an enhanced intervention that also sent ITEMs timed to participants' quit efforts. Outcomes were compared in 199 participants receiving the one-time intervention and 286 receiving ITEMs.MeasurementsDemographic factors, number of cigarettes smoked, nicotine addiction, depressive symptoms, and confidence in ability to quit were measured at entry. Twenty-four–hour quit attempts and seven-day point-prevalence of abstinence (nonrespondents assumed to smoke) were measured 30 days after each subject's self-selected quit date.ResultsThe one-time and ITEMs groups differed in some demographics and some relapse risk factors but not in factors associated with 30-day quit rates. ITEMs appeared to increase the rate at which individuals set quit dates (97% vs. 91%, p = 0.005) and, among the respondents to follow-up questionnaires (n = 145), the rate of reported 24-hour quit efforts (83% vs. 54%, p = 0.001). The 30-day intent-to-treat quit rates were higher in the ITEMs group: 7.5% vs. 13.6%, p = 0.035. In multivariate analyses controlling for differences between groups, receiving ITEMs was associated with an increase in the odds ratio for quitting of 2.6 (95% confidence interval = 1.3–5.3).ConclusionITEMs sent on strategic days in smokers' quit efforts enhanced early success with smoking cessation relative to a single-point-in-time Web intervention. The effect appears to be mediated by ITEMs' causing smokers to plan and undertake quit efforts more frequently.     

The psychological morbidity in the long term after war related bilateral lower limb amputation

BackgroundTo determine the psychological morbidity in the long term after war related bilateral lower limb amputation.MethodsMental health status was determined by the Symptom Checklist-90-R (SCL-90-R) and a structured psychiatrist interview using Structured Clinical Interview for DSM Disorders-IV (SCID-IV) in 327 male amputees. The survey was 22.3 (SD = 3.9) years after amputation. A one-sample t-test was conducted to compare our results with a survey carried out in a rural Iranian population.ResultsThe mean age of the participants was 42 years (SD = 6.3). Only 22 persons had psychiatric diagnosis and were under treatment. The most common problems on SCL-90-R were somatization, obsessive-compulsive, interpersonal sensitivity, anxiety, and depression. Global severity index (GSI) of the bilateral lower limb amputees (BLLA) (0.88 ± 0.63) was significantly higher than Iranian population (0.35 ± 0.28) (p < 0.001). BLLA had significantly higher scores in all subscales of Scl-90-R compared with general population (p < 0.001). Of the total amputees about 39.1% (128 out 327) diagnosed with at least one psychiatric disorder in psychiatrist interview. About 83.9% (N = 115) of the psychiatrist diagnosed disorders were new cases. Mood disorders 37.3% (depression 28.7%) and anxiety disorders 12.2% (obsessive compulsive disorder 9.8%) were the most common disorders in the study group. There was not any relationship between demographic variables and mental disorder (p > 0.05).ConclusionThe high prevalence and especially the large proportion of undiagnosed mental disorders high-light the need for targeted and appropriate psychological interventions in this vulnerable population.     

Comparison between Standing Broad Jump test and Wingate test for assessing lower limb anaerobic power in elite sportsmen

BackgroundLower limb explosive power is an important motor quality for sporting performance and indicates use of anaerobic energy systems like stored ATP and Creatine phosphate system. Weightlifting, Fencing and Wrestling use it for monitoring and identification of potential sportsmen. The Wingate test and Standing Broad Jump (SBJ) test are reliable and accurate tests for its assessment. This study conducted on elite Indian sportsmen tries to analyse feasibility of use of the SBJ test in sports and military medicine when Wingate test is impractical.Methods95 elite sportsmen (51 Fencers, 17 Weight lifters and 27 Wrestlers) of a sports institute were administered Wingate cycle ergometer test and SBJ under standardised conditions. The results were analysed for mass and inter-discipline correlation.ResultsAnalysis using Pearson's correlation showed significant positive correlation between Peak power (r = 0.446, p < 0.0001) and SBJ (distance) in all sportsmen. Inter-sport correlation showed positive correlation between SBJ and peak power (r = 0.335, p < 0.016) in Fencers and between SBJ, peak power (r = 0.686, p < 0.002) in Weightlifters. Bland–Altman plot analysis showed that about 94% pairs of peak power and SBJ were within limits of agreement for each discipline as well as among all sportsmen.ConclusionThe test results show definite correlation and SBJ test can be used as a field test in performance monitoring, talent identification, military recruit screening and injury prevention.     

Portosystemic collaterals are not prerequisites for the development of hepatic encephalopathy in cirrhotic rats

BackgroundLiver functions and portosystemic collaterals influence the development and severity of hepatic encephalopathy (HE) in cirrhosis. However, it has not been examined which factor has a greater influence or if shunts can be used to determine the presence and severity of HE. The expression of tumor necrosis factor-α (TNF-α) is increased in cirrhosis, and its role in HE deserves further evaluation.MethodsPortal hypertension was induced by portal vein ligation (PVL; a model of high-degree portosystemic shunting without significant liver damage) and liver cirrhosis was induced by bile duct ligation (BDL; a model of low-degree shunting with liver cirrhosis) in male Spraque-Dawley rats. Sham-operated rats were used as controls. Motor activity counts, hemodynamic parameters, plasma levels, liver biochemistry parameters, TNF-α, and a flow-pressure curve study of portosystemic collaterals (where a higher slope indicates fewer portosystemic collaterals) were performed on Day 7 after PVL and Week 5 after BDL.ResultsPortal pressure was significantly higher in the PVL and BDL groups than in controls. The liver biochemistry parameters, TNF-α, and motor activities were not significantly different between the PVL and PVL-control groups. In the BDL group, TNF-α, AST, and total bilirubin levels were significantly higher and the motor activity counts were lower than in the BDL-control group. Moreover, in the BDL rats, TNF-α (p = 0.037, R = -0.490), AST (p = 0.007, R = -0.595) and total bilirubin (P = 0.001, R = ?0.692) levels, but not the slopes of the flow-pressure curves, were significantly and negatively correlated with the motor activity counts.ConclusionThe presence of a high degree of portosystemic shunting without significant liver damage may not be adequate for the development of HE.     

Exhaled nitric oxide as a guiding tool for bronchial asthma: A randomised controlled trial

BackgroundEvidence regarding the role of non-invasive marker of airway inflammation, fractional exhaled nitric oxide (FeNO) to guide asthma treatment is equivocal. We aimed to evaluate if the use of FeNO to adjust inhaled corticosteroid treatment resulted in reduced daily corticosteroid use and lesser exacerbations.Methods100 patients of bronchial asthma in the age group of 12–70 years were randomised to receive inhaled corticosteroids based on either FeNO measurements (n = 50) or as per Global Initiative for Asthma (GINA) guidelines. Follow up was done every 2 months for period of 12 months. Results were compared in terms of mean daily inhaled corticosteroid use and number of exacerbations.ResultsAfter the follow up period of 12 months, mean daily dose of ICS (SD) required in FeNO group was 267.5 μg (126.29), as opposed to control group in which mean daily dose of steroid was 320.00 μg (138.69). However this observed difference in steroid dose was statistically insignificant (p value = 0.061). The estimated mean (SD) rate of asthma exacerbation experienced in follow up period of 12 months in FeNO group was 0.3 episodes (0.54) per patient per year (95% confidence interval, 0.145–455) and 0.4 episodes (0.61) per patient per year in control group (95% confidence interval, 0.228–572). However this difference in rate of exacerbations between the two study groups was not statistically significant (p = 0.387).ConclusionFeNO guided management strategy for asthma did not result in statistically significant reduction in dose of inhaled corticosteroids or number of asthma exacerbations.     

Factors that influence survival in colorectal cancer with synchronous distant metastasis

BackgroundTreatments for the purposes of curing or more effectively managing metastatic colorectal cancer (CRC) are evolving. Our study focused on patients with primary CRC with synchronous distant metastasis, and we analyzed the factors influencing patient survival.MethodsData review was conducted retrospectively. Clinicopathological parameters included age, sex, site of primary cancer, tumor cell differentiation, number of liver metastasis, presence of extrahepatic metastasis, treatment of liver metastasis, pre-treatment carcinoembryonic antigen (CEA) level, status of treatment response, salvage treatment and survival.ResultsA total of 420 patients were identified and considered for our study. Of those, 275 patients (65.4%) had liver-only metastasis, 100 patients (23.8%) had concomitant lung metastasis, and 40 patients (9.5%) had other metastases. Additionally, 145 patients (34.5%) had liver-directed treatment including surgical resection (28.5%), radiofrequency ablation (RFA) (10.6%) and transcatheter arterial chemoembolization (TAE) (1.2%). There were 80 patients (19%) with CEA levels < 10, 135 patients (32.1%) with CEA 10–100, and 165 patients (39.2%) with CEA > 100. There were 200 patients (47.6%) who had received chemotherapy, 130 patients (30.9%) with target therapy, and 40 patients (9.5%) who had not undergone any salvage treatment. Three significant factors were identified, including treatment of liver metastasis (p = 0.027), pre-treatment CEA (p = 0.04), and salvage treatment (p = 0.005).ConclusionWe demonstrated three factors influencing patient survival including treatment of liver metastasis, pre-treatment CEA level, and salvage treatment. Aggressive treatment of liver metastasis including surgical resection or RFA combined with chemotherapeutic agents appear to provide an increased rate of survival to patients.     

Tobacco use among serving army personnel: An epidemiological study

BackgroundIndia has consequential burden of tobacco related disease and death. Though there are surveys conducted at national and regional level yet the information about tobacco consumption among army personnel is scarce. Thus an epidemiological study was conducted to estimate the prevalence and assess determinants of tobacco consumption amongst army personnel.MethodsA community based cross sectional study was conducted using simple random sampling to enroll 380 personnel. Data was collected using a pretested and validated questionnaire with relevant domains.ResultsThe age of participants was 33 + 7 years. The prevalence of ever tobacco users was 47.90% (95% CI: 42.78–53.05) and of current tobacco users was 35.00% (95% CI: 30.21–40.03). No association was found between ever users and age group, monthly income, occupation, length of service, family member usage (p > 0.05). Among smokeless tobacco forms, Khaini was most preferred (49.45%) followed by Gutkha. Majority of them (41.21%) were moderate tobacco chewers. Tobacco user friends (53.85%) were the main stimulants, which induced respondents to start tobacco. The important source of tobacco procurement was local vendor. 91.76% ever user were aware of the ill-effects of the tobacco use. There was statistically significant association for knowledge regarding tobacco use being harmful to family members between current users and ever users (p = 0.036).ConclusionThe study highlights a high prevalence of tobacco user amongst army personnel. Reduction of easy accessibility, Behaviour Change Communication activities and stricter implementation of regulations are urgently required.     

Shrinkage of head and neck cancer specimens after formalin fixation

BackgroundWe conducted this study to investigate whether formalin fixation is associated with the shrinkage of head and neck cancer specimens.MethodsPatients scheduled to undergo operation were eligible for enrollment. Fresh specimens were measured immediately in the operating room, and the measurements were repeated after formalin fixation.ResultsA total of 100 specimens were collected. Nearly half of them were obtained from the oral cavity (n = 49), and a large majority were squamous cell carcinoma (n = 69). The average decreases in length, width, and depth after formalin fixation were 1.50 mm (4.40%), 1.52 mm (6.18%), and 0.67 mm (4.10%), respectively. There was no significant difference in the shrinkage percentage associated with gender, age, tumor site, tumor size, or histology.ConclusionWe found that head and neck cancer specimens shrink after formalin fixation. Therefore, we recommend that the specimen be measured immediately in order to avoid the underestimation of tumor size.     

Effectiveness of an intervention package on knowledge,attitude, and practices of food handlers in a tertiary care hospital of north India: A before and after comparison study

BackgroundFood-borne illnesses have been a recognized hazard for decades. Recent promulgation of Food Safety and Standards Act (FSSA), 2006, indicates the concern of our Govt. for food safety. Research on effectiveness of food safety interventions in our country is remarkably scarce. Hence, the present study was conducted in a tertiary care hospital of north India to create evidence-based results for food safety interventions.MethodsThe study was before and after intervention trial which was registered with CTRI. Data collection was paperless using a software. All food handlers (n = 280) working inside the hospital were recruited. Intervention package comprised Self-Instructional Manual in Hindi for food handlers, short film for sensitization of food handlers on food safety titled ‘Gravy Extra’, and a documentary titled ‘Food Safety from farm to Fork’. Chi square test, paired t test, and Wilcoxon sign rank test were used.ResultsThe mean age of food handlers was 35 ± 2 years. Majority (61.7%) of food handlers were educated less than 10th standard. Nearly 60% of them had up to five years of experience. At base line majority (68.9%) had a fair knowledge about food safety issues. There was a significant improvement in food safety knowledge and practice score of food handlers after the intervention (p < 0.05). Their attitude toward food safety changed in a positive direction (p < 0.05).ConclusionThe intervention package was useful in improving the knowledge, creating a positive attitude and enhancing the food safety practices of food handlers working inside a tertiary care hospital.     

To evaluate the safety and efficacy of the TVT-Secur procedure in the treatment of stress urinary incontinence in women

BackgroundThe prevalence of stress urinary incontinence (SUI) in the middle-aged Indian women is around 16%. The use of transvaginal tapes (TVTs) has revolutionised the surgical management of SUI. Patients who undergo placement of the tape via the transobturator route often complain of persistent thigh pain at the site of trocar insertion. The use of minimally invasive tapes with a single suburethral incision reduces surgical trauma by eliminating thigh incisions, while maintaining the cure achieved by conventional TVTs. The study was conducted to test the efficacy and safety of minimally invasive TVT-Secur tape placement for treatment of SUI in women.Methods20 women with stress incontinence were implanted with TVT-Secur tapes and followed up for a year.ResultsThe objective cure rate of SUI was 85% at the end of a year. The improvement in the patient satisfaction and Incontinence-specific QOL scores, of both Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7), was statistically significant at 95% and 99% confidence levels. There were no complaints of thigh pain; however, there were intraoperative complications in the form of bladder perforation in 5% (n = 1), urethral injury in 5% (n = 1) and urethral tape exposure in 10% (n = 2), at 3 months requiring tape sectioning.ConclusionsThese cure rates and complications are comparable to the standard TVT implantations at the end of a year, without thigh pain; however, a greater number of patients and a longer follow-up is required to see whether the long-term cure is maintained or not, before recommending the same as a standard of treatment.     

Are self-expandable metal stents superior to plastic stents in palliating malignant distal biliary strictures? A meta-analysis and systematic review

BackgroundPalliation for inoperable malignant distal biliary strictures can be achieved with self-expandable metal stents (SEMS) and plastic stents (PS). This is a meta-analysis to compare PS and SEMS. The aim of the study is to compare clinical outcomes in patients with SEMS and PS.MethodsStudy selection criteria were studied using SEMS and PS for palliation in patients with malignant distal biliary stricture. For data collection and extraction, articles were searched in Ovid journals, Medline, Cochrane database, and Pubmed. Pooled proportions were calculated using both Mantel–Haenszel method and DerSimonian Laird method for statistical analysis.ResultsInitial search identified 1376 reference articles, of which 112 were selected and11 studies (N = 947) were included in this analysis. Pooled analysis showed SEMS patency to be 167.7days (95% CI = 159.2–176.3) compared to 73.3days (95% CI = 69.8–76.9) in PS. SEMS have lower odds of occlusion when compared to PS with an odds ratio of 0.48 (95% CI = 0.34–0.67). SEMS has a lower odds of cholangitis compared to SP, with an odds ratio of 0.46 (95% CI = 0.30–0.69).ConclusionSEMS seem to be superior to PS with better patency periods and survival duration. SEMS have lower occlusion rates, re-intervention rates, and cholangitis.     

Electrophysiological characterization of Charcot–Marie–Tooth disease type 1A in Taiwan

BackgroundCharcot–Marie–Tooth disease type 1A (CMT1A) is the most common type of hereditary neuropathy. The demyelinating pathology of CMT1A results in significant nerve conduction slowing such that a nerve conduction study (NCS) is important in the clinical assessment of CMT1A. In this study, we analyzed and reported the electrophysiological features of a large Taiwanese cohort with CMT1A.MethodsWe retrospectively analyzed the NCS data of 106 Taiwanese patients with CMT1A. We also compared the electrophysiological parameters of the CMT1A patients with those of 20 patients with early-onset Charcot–Marie–Tooth disease type 1B (CMT1B).ResultsThe patients with CMT1A had a significant but variable degree of slowed nerve conduction. The median motor nerve conduction velocities (MNCVs) varied from 10.0 to 37.3 m/s in the entire CMT1A cohort but were more concordant in patients within a family (p < 0.001). In each patient, the MNCVs among different nerves were concordant (p < 0.001), and the MNCVs tended to remain steady longitudinally. Moreover, younger patients had a slower MNCV than older patients within the CMT1A population (p < 0.001). The average median MNCV was significantly faster in the CMT1A patients than in the CMT1B patients (21.8 ± 6.2 m/s and 16.3 ± 3.6 m/s; p < 0.001).ConclusionThis study provides basic electrophysiological knowledge about CMT1A in Taiwan. The findings also suggest that the electrophysiological variability in the CMT1A cohort may be at least partially attributable to unknown genetic factors. These data emphasize the role of MNCV in the clinical assessment of CMT1A. A median or ulnar MNCV below 38 m/s can be a sensitive criterion for supporting the diagnosis of CMT1A. A median MNCV can sometimes help to distinguish CMT1A from CMT1B, and CMT1A should be considered in patients with median MNCVs near or above 24 m/s. Moreover, the MNCV may to some degree reflect the severity of CMT1A.     

Delayed primary closure versus primary closure for wound management in perforated appendicitis: A prospective randomized controlled trial

BackgroundIt is still a matter of debate whether delayed primary closure (DPC) of contaminated abdominal incisions reduces surgical site infections compared with a primary closure (PC). The aim of this study was to determine the optimal method of wound closure for patients with perforated appendicitis.MethodsA total of 70 patients with perforated appendicitis were included. They were randomized to have their surgical incisions (skin and subcutaneous tissue) either PC or left open with Betadine-soaked gauze packing for DPC on the fifth postoperative day or later if the wound conditions were inappropriate for closure. A wound was considered infected if pus discharged from the incision site. The main outcome measures were the incidence of wound infection and the length of hospital stay (LOS).ResultsIn the entire series, wound infection developed after incision closure in 21.4% of the patients. The PC group had a higher incidence of wound infection (38.9% vs. 2.9%, p < 0.001) and longer LOS (8.4 days vs. 6.3 days, p = 0.038).ConclusionDelayed primary closure is the optimal management strategy for perforated appendicitis wounds. It significantly reduces the wound infection rate and length of stay.