Psychological Correlates of Outcome after Coronary Artery Bypass Graft

Background

Psychological effects of Coronary Artery Bypass graft (CABG) have been of interest all over the world but there is a paucity of Indian work.

Methods

30 patients undergoing CABG at a service hospital were included. All patients filled a specially designed proforma. Mini Mental Status Examination, Hospital anxiety and depression scale, Coronary scale, Seattle angina questionnaire and Euro-QOL 5D were performed before and seven days after CABG.

Results

43.3% had significant anxiety and 30% had significant depression before CABG. Following CABG, 36.67% of the patients had significant anxiety while 40% had significant depression. On the Seattle angina questionnaire, physical limitation reduced from 71.6 ± 7.9 to 53.1 ± 14.6. There was significant improvement in treatment satisfaction from 37.8 ± 6.1 to 59.4 ± 4.2 following CABG. On th euro quality of life scale (EQ5D) health status improved from 38.17 ± 9.51 before CABG to 68.5 ± 5.28 after CABG.

Conclusion

There is a significant incidence of anxiety and depression in patients undergoing CABG, both before and after surgery.Key Words: CABG, anxiety, depression     

A method and knowledge base for automated inference of patient problems from structured data in an electronic medical record

Background

Accurate knowledge of a patient''s medical problems is critical for clinical decision making, quality measurement, research, billing and clinical decision support. Common structured sources of problem information include the patient problem list and billing data; however, these sources are often inaccurate or incomplete.

Objective

To develop and validate methods of automatically inferring patient problems from clinical and billing data, and to provide a knowledge base for inferring problems.

Study design and methods

We identified 17 target conditions and designed and validated a set of rules for identifying patient problems based on medications, laboratory results, billing codes, and vital signs. A panel of physicians provided input on a preliminary set of rules. Based on this input, we tested candidate rules on a sample of 100 000 patient records to assess their performance compared to gold standard manual chart review. The physician panel selected a final rule for each condition, which was validated on an independent sample of 100 000 records to assess its accuracy.

Results

Seventeen rules were developed for inferring patient problems. Analysis using a validation set of 100 000 randomly selected patients showed high sensitivity (range: 62.8–100.0%) and positive predictive value (range: 79.8–99.6%) for most rules. Overall, the inference rules performed better than using either the problem list or billing data alone.

Conclusion

We developed and validated a set of rules for inferring patient problems. These rules have a variety of applications, including clinical decision support, care improvement, augmentation of the problem list, and identification of patients for research cohorts.     

Effect of bacteriophage lysin on lysogens

Objective

To study the effect of phage lysin on the growth of lysogens.

Methods

Sputum specimens processed by modified Petroff''s method were respectively treated with phagebiotics in combination with lysin and lysin alone. The specimens were incubated at 37 °C for 4 days. At the end of day 1, 2, 3 and day 4, the specimens were streaked on blood agar plates and incubated at 37 °C for 18-24 hours. The growth of normal flora observed after day 1 was considered as lysogens.

Results

Sputum specimens treated with phagebiotics-lysin showed the growth of lysogens. When specimens treated with lysin alone, lysogen formation was avoided and normal flora was controlled.

Conclusions

Lysin may have no effect on the growth of lysogens.     

Changes with time in skin temperature of the shoulders in healthy controls and a patient with shoulder-hand syndrome

Background

Abnormal skin temperature in the shoulder is caused by various diseases. A thermography is unable to capture temperature changes over time. In contrast, a Thermocron is an effective measuring device to monitor temperature changes over time.

Purposes

The purposes of this study employing a Thermocron were to measure shoulder skin temperature over time in healthy subjects and to detect shoulder skin temperature abnormalities in a patient with shoulder-hand syndrome.

Subjects and methods

Subjects comprised 10 healthy volunteers (20 shoulders; 4 men and 6 women, mean age 54 years). For measurements, a Thermocron was attached on both shoulders. Measurements were made from 21.00 to 07.00 the following morning at 15-minute intervals.

Results

Gradual difference in right and left shoulder skin temperature was observed with the timing of measurements but no significant difference was apparent, i.e. dominant side 34.9 ± 0.8°C, non-dominant side 34.9 ± 0.9°C (P = 0.28).

Presentation of a case with shoulder-hand syndrome

A 54-year-old woman with the diagnosis of rotator cuff tear underwent surgical treatment of rotator cuff repair, but the pain of the operated shoulder persisted due to phase 1 shoulder-hand syndrome. In postoperative week 3, skin temperature measurement using Thermocrons demonstrated a significant decrease in temperature on the operated side (affected side 34.3 ± 0.4°C, healthy side 35.2 ± 0.3°C; P < 0.05).

Conclusion

The changing of the skin temperature during night-time was successfully recorded both in the healthy subjects and a case with shoulder-hand syndrome using a Thermocron.     

Restoration of horizontal stability in complete acromioclavicular joint separations: surgical technique and preliminary results

Background

Our purpose was to investigate the clinical efficacy of arthroscope-assisted acromioclavicular ligament reconstruction in combination with double endobutton coracoclavicular ligament reconstruction for the treatment of complete acromioclavicular joint dislocation.

Methods

During the period from February 2010 to October 2012, ten patients with Rockwood types IV and V acromioclavicular joint dislocation were hospitalized and nine were treated with acromioclavicular ligament reconstruction combined with double endobutton of coracoclavicular ligament reconstruction. The improvement in shoulder functions was assessed using a Constant score and visual analog scale (VAS) system.

Results

The mean follow-up period was 33.6 ± 5.4 months. The mean Constant scores improved from 25.2 ± 6.6 preoperatively to 92.4 ± 6.5 postoperatively, while the mean VAS score decreased from 5.9 ± 1.4 to 1.2 ± 0.9; significant differences were observed. The final follow-up revealed that excellent outcomes were achieved in eight patients and good outcome in two patients.

Conclusion

Arthroscope-assisted acromioclavicular ligament reconstruction in combination with double endobutton of coracoclavicular ligament reconstruction is an effective approach for treatment of acute complete acromioclavicular joint dislocation.     

Adrenaline,Noradrenaline and Dopamine Level Estimation in Depression : Does it Help?

Background

Abnormalities of catecholaminergic function have been hypothesised in causation of depressive illness. Electroconvulsive therapy (ECT) is postulated to have noradrenergic mechanism of action. We studied the clinical utility of estimating catecholamines level changes after ECT.

Methods

Plasma adrenaline, noradrenaline and dopamine in healthy controls and depressed patients were estimated by high performance liquid chromatography with electrochemical detection method before and after ECT.

Result

Mean ± standard deviation of plasma adrenaline, noradrenaline and dopamine in controls was 36.7 ± 13.2, 209.3 ± 76, 21.8 ± 9.5 ng/L respectively, while in depressed patients before and after ECT it was found to be 32.5 ± 12.0, 419.3 ± 167.7, 22.1 ± 16.0ng/ L and 37.2 ± 19.6, 386.1 ± 168.4, 22.3 ± 15.5ng/L respectively. Correlation of adrenaline, noradrenaline and dopamine concentration with scores of Beck Depression Inventory, Suicidal Ideation Scale and Melancholia Inventory was positive but statistically not significant and poor. Based on the cut off values of noradrenaline, only 62% cases could be categorized as abnormal, which after ECT reduced to 50%, whereas post ECT psychiatric ratings was normal in about 78% cases.

Conclusion

There is no clinical significance of estimating adrenaline, noradrenaline and dopamine in depressed patients.Key Words: Electroconvulsive therapy, Adrenaline, Noradrenaline, Dopamine, Psychiatric scales     

Comparative Study of Recovery after Sevoflurane versus Halothane Anaesthesia in Adult Patients

Background

Induction and maintenance characteristics of sevoflurane and halothane have been studied, but little work has been done to compare the postoperative recovery of these two agents.

Methods

Sixty adult, ASA I and II patients were allocated randomly into Group A and Group B of 30 each. Group A received sevoflurane and Group B received halothane for maintenance. At the end of surgery early recovery, intermediate recovery and discharge criteria were assessed.

Results

Early recovery assessed with the mean time to extubation was 6.7 ± 2.29 min in Group A and 9.07 ± 1.64 min in Group B; eye opening was 7.28 ± 2.3 min in Group A and 10.6 ± 1.77 min in Group B; response to verbal command was 8.52 ± 2.83 min in Group A and 12.33 ± 2.17 min in Group B, while orientation was 10.43 ± 3.15 min in Group A and 14.77 ± 2.66 min in Group B. These differences were statistically significant (p<0.001). The mean time to reach post anaesthesia care unit discharge criteria was shorter for Group A (21.1 ± 4.69 min) as compared to Group B (27.43 ± 6.51 min) and this difference was statistically significant (p<0.001)

Conclusion

Early recovery time and time taken to achieve discharge criteria were faster with sevoflurane.Key Words: Sevoflurane, Halothane, Post-operative recovery     

Comparison of Phaconit Rollable IOL with Acrylic Foldable IOL

Background

Phaconit or ultra micro incision phacoemulsification cataract surgery involves phacoemulsification through a 0.9 millimetre sleeveless phaco tip and irrigating chopper followed by implantation of a rollable intraocular lens. The procedure leads to negligible astigmatism and faster visual recovery as compared to phacoemulsification with a foldable intraocular lens.

Methods

This prospective study analysed 80 cases of sub millimetre phaconit surgery with implantation of rollable intraocular lenses(IOL) in 40 cases and acrylic foldable IOL in the remaining 40 cases. Evaluation of efficacy and adaptability of procedure, equipment settings, operative constraints, postoperative complications, keratometric and topographic evaluation of induced astigmatism with visual outcome and patient''s rehabilitation were studied.

Results

The intraoperative complications were surge/ chamber collapse in 16 (20%), iris chaffing in one and corneal burns in two cases. All cases had an induced astigmatism of less than or equal to ± 0.25 D in four to six weeks after rollable IOL and ± 0.5 D to ± 0.75 D after acrylic IOL implantation. All patients had best-corrected visual acuity of 6/6 by third post operative day.

Conclusion

Phaconit with rollable IOL is a perfect blend of surgical skill, application of technology and ultra thin IOL.Key Words: Phaconit, Ultra micro phaco, Submillimetre incision, Rollable IOL implantation     

Semen profiles of young men involved as bicycle taxi cyclists in Mangochi District,Malawi: A case-control study

Aim

The purpose of this study was to evaluate the semen profiles of bicycle taxi cyclists and healthy controls in Mangochi district, Malawi.

Methods

Semen samples were collected from young bicycle taxi cyclists after two to three days of sexual abstinence. A control group, comprising young men who were not bicycle taxi operators also submitted semen samples. Samples were left to liquefy for 30 minutes before measurements were conducted of volume, concentration, total motility, and progressive motility. This was followed by preparation of morphology slides. Light microscopy was used for sperm analysis.

Results

Semen parameters such as volume (1.66 ± 0.18 mL vs. 3.64 ± 0.17 mL; p = 0.0001), concentration (28.31 ± 4.33 x 106/mL vs. 54.95 ± 5.93 × 106/mL; p = 0.02) , total motility (56.98% ± 8.22% vs. 56.98% ± 8.22%; p = 0.03), progressive motility (22.57% ± 3.35% vs. 59.69% ± 4.82%; p = 0.004), and morphology (6.98% ± 3.23% vs. 19.73% ± 2.32%; p = 0.006) were significantly reduced in the bicycle taxi cyclists compared to the healthy controls.

Conclusion

In this case-control study, bicycle taxi operators had lower semen volume, concentration, total motility, and progressive motility, as well as a higher concentration of abnormally shaped spermatocytes, compared to healthy controls.     

Pedalium murex Linn (Pedaliaceae) fruits: a comparative antioxidant activity of its different fractions

Objective

To examine the antioxidant activity and total phenolic content of different solvent fractions of Pedalium murex (P. murex) Linn fruits (Family: Pedaliaceae) as well as the correlation between the total antioxidant capacity and total phenolic content.

Methods

In the present study, the antioxidant activities of P. murex were evaluated using six in-vitro assays, namely total antioxidant assay, DPPH assay, reducing power, nitric oxide scavenging, hydrogen peroxide scavenging and deoxyribose scavenging assays, and total phenol contents were also investigated.

Results

The ethyl acetate (EA) fraction was found to have high levels of phenolic content (298.72±2.09 mg GAE/g). The EA fraction exhibit higher total antioxidant capacity, higher percentage of DPPH radical scavenging activity (135.11±2.95µg/mL), nitric oxide (200.57±4.51µg/mL), hydrogen peroxide (217.91±6.12 µg/mL), deoxyribose (250.01±4.68µg/mL) and higher reducing power. Correlation coefficient (r²=0.914) was found to be significant between total phenolic content and total antioxidant activity.

Conclusions

In general, the results indicate that the EA fractions are rich in phenolic antioxidants with potent free radical scavenging activity implying their importance to human health.     

Effect of insulin on Blattela germanica Linnacus

Objective

To determine the sensitivity of Blattela germanica L (B. germanica L) to differenct doses of insulin.

Methods

B. germanica were reared in laboratory conditions at (25±2) °C and (50±5)% relative humidity (RH), and exposure period of 12:12 L/D. Different concentrations, viz. 5, 10, 15, 20 and 25 µ of insulin N, R, (N+R) were prepared and injected to 10 treated cockroaches with another 10 cockroaches which were injected with normal saline as control group.

Results

Insulin N with a dose of 20 µ caused more than 70% mortality of B. germanica in this study. There was a significant difference between 20 µ of insulin N with other doses of 5, 10, 15 and 25 µ, and its comparison with other forms of medication also showed obvious difference (P<0.05).

Conclusions

It can be concluded that effective drug doses of insulin which can be used as posion bait or gel against German cockroaches could be utilized in the control of B. germanica in the future field studies.     

Verapamil as an Adjunct to Local Anaesthetic for Brachial Plexus Blocks

Background

Calcium channel blockers potentiate the effects of local anaesthetics. We examined the effect of adding verapamil to local anaesthetic solution on anaesthetic duration in patients undergoing surgery under brachial plexus block.

Methods

This study was a prospective, randomized, controlled, double blind study. Sixty patients undergoing elective upper limb surgery were divided into two groups of 30 each. Group A received 40 ml of 1% lignocaine with 0.25% bupivacaine, while Group B patients had 2.5 mg verapamil added.

Result

Onset of sensory blockade time was marginally faster in Group B (23.2 ± 3.94 minutes) as compared to Group A (23.9 ± 4.13 minutes). However this difference was statistically not significant. The increase in duration of sensory blockade in Group B (185 ± 46.52 minutes) as compared to Group A (157 ± 44.28 minutes) was statistically significant (p= 0.011). Increase in duration of motor blockade in Group B (161 ± 46.14 minutes) as compared to Group A (149 ± 42,76 minutes) was statistically not significant (p = 0.15). Similarly prolongation of analgesic duration in Group B (318 ± 69.54minutes) as compared to Group A (302 ± 0.69 minutes) was statistically not significant (p=0.18).

Conclusion

We conclude that adding verapamil to brachial plexus block can prolong sensory anaesthesia without any effect on analgesic duration.Key Words: Brachial plexus block, Verapamil     

Sustainability of a Curriculum-based Intervention on Dietary Behaviours and Physical Activity among Primary School Children in Trinidad and Tobago

Objectives:

Childhood obesity and poor lifestyle practices are emerging as major public health challenges in the Caribbean. Given the fact that a significant part of childhood is spent at school, curriculum-based interventions aimed at improving good dietary and physical activity patterns may provide a useful vehicle for mass inculcation of long-term healthy lifestyle practices. In this study, we evaluated the long-term impact of a brief curriculum based intervention on dietary behaviour, physical activity and knowledge level of primary schoolchildren.

Methods:

The study was a randomized, controlled, school-based nutrition education and physical activity intervention. One hundred students each were then randomly assigned to the intervention (IVG) and non-intervention (NIVG) groups and followed-up for 18 months. Participants in the IVG group were exposed to a curriculum consisting of six one-hour modules followed by school-based activities geared at fostering healthy behaviours. Students in the non-intervention group did not receive any modules and were subject to the information available at school on a regular basis.

Results:

In multivariate regression equations controlling for age, gender, body mass index (BMI) and baseline values, intervention was associated with lower intake of fried foods and sodas (p < 0.05) and higher knowledge scores (p < 0.01) 18 months later but not significantly associated with improved physical activity or lower BMI.

Conclusions:

In this study, participants in the intervention group reported significantly lower intakes of fried foods and sodas and higher knowledge scores than participants in the control group some 18 months post-intervention independent of age, gender, BMI, ethnicity and the intakes at baseline.     

Use of the Complete Rockall Score and the Forrest Classification to Assess Outcome in Patients with Non-variceal Upper Gastrointestinal Bleeding Subject to After-hours Endoscopy: A Retrospective Cohort Study

Objectives:

To evaluate the usefulness of the Forrest classification and the complete Rockall score with customary cut-off values for assessing the risk of adverse events in patients with upper gastrointestinal bleeding (UGI-B) subject to after-hours emergency oesophago-gastro-duodenoscopy (E-EGD) within six hours after admission.

Methods:

The medical records of patients with non-variceal UGI-B proven by after-hours endoscopy were analysed. For ''high risk'' situations (Forrest stage Ia–IIb/complete Rockall score > 2), univariate analysis was conducted to evaluate odds ratio for reaching the study endpoints (30-day and one-year mortality, re-bleeding, hospital stay ≥ 3 days).

Results:

During the study period (75 months), 86 cases (85 patients) met the inclusion criteria. Patients ''age was 66.36 ± 14.38 years; 60.5% were male. Mean duration of hospital stay was 15.21 ± 19.24 days. Mortality rate was 16.7% (30 days) and 32.9% (one year); 14% of patients re-bled. Univariate analysis of post-endoscopic Rockall score ≥ 2 showed an odds ratio of 6.09 for death within 30 days (p = 0.04). No other significant correlations were found.

Conclusion:

In patients with UGI-B subject to after-hours endoscopy, a ''high-risk'' Rockall score permits an estimation of the risk of death within 30 days but not of re-bleeding. A ''high-risk '' Forrest score is not significantly associated with the study endpoints.     

Crown Cementing Strategy for Naval Divers

Background

A large number of personnel working in hyperbaric environment such as divers and submariners during escape drills report to the out patient department with split teeth, displacement of restoration and pain during ascent after diving. These symptoms are probably attributable to dental barotraumas. Therefore, a need was felt to undertake a study in this area, with a specific interest for treating these patients.

Methods

Sixty extracted single rooted premolar teeth were prepared and full cast crowns were cemented. Out of these, 20 were prepared with zinc phosphate, 20 with glassionomer and 20 with resin cement. After seven days of storage, each of the teeth in experimental group was pressure cycled 15 times to 3 atmospheres after which the force required to dislodge the crowns was tested on an Instron testing machine.

Result

A significant difference was found (student''s t test p value < 0.01) between the force required to dislodge the crowns with zinc phosphate cemented control group (141.70 ± 38.62) and experimental group (16.92 ± 10.13). Similarly a significant difference was observed in the glassionomer cemented control group (184.33 ± 25.33) and experimental group (90.50 ± 34.07). On the other hand, no difference was found between the resin cemented control group (289.15 ± 81.48) and experimental (279.43±87.48) group.

Conclusion

Within the limitations of this study and based on the results, it was concluded that environmental pressure cycling affected the retention of crowns cemented with zinc phosphate and glassionomer cement. Panavia resin cement used in this study appeared to be unaffected by environmental pressure cycling. On the basis of the results of this study, dental surgeons should consider cementing fixed prosthesis with resin cements for patients who are exposed to marked variations in environmental pressure, such as divers and submariners during escape drills.Key Words: Barodontalgia, Crowns, Luting cements     

Effects of bisoprolol and cilazapril on the central retinal artery blood flow in patients with essential hypertension—preliminary results

Background

A growing body of evidence suggests that effective blood pressure reduction may inhibit the progression of microvascular damage in patients with essential arterial hypertension. However, the potential influence of anti-hypertensive drugs on ocular circulation has not been studied sufficiently.

Purpose

The aim of our study was to evaluate the effects of anti-hypertensive therapy on blood flow in the central retinal artery in patients with systemic arterial hypertension.

Material and methods

Twenty patients with essential arterial hypertension, aged 32–46 years, were examined with Doppler ultrasonography (10 MHz ultrasound probe). Blood flow velocities, pulsatility, and vascular resistance were determined before and 3 hours after systemic application of either bisoprolol 5 mg or cilazapril 2.5 mg.

Results

Administered bisoprolol significantly decreased maximum (9.8 ± 0.5 cm/s versus 8.5 ± 0.6 cm/s; P < 0.05) and minimum (2.75 ± 0.19 cm/s versus 1.75 ± 0.27 cm/s; P < 0.02) velocity, increased the Pourcellot''s index (0.71 to 0.79; P < 0.05) in central retinal artery. There were no statistically significant changes in central retinal artery blood flow after administration of cilazapril.

Conclusion

Systemic application of beta-blockers may unfavourably disturb the ocular blood flow.     

Automated concept-level information extraction to reduce the need for custom software and rules development

Objective

Despite at least 40 years of promising empirical performance, very few clinical natural language processing (NLP) or information extraction systems currently contribute to medical science or care. The authors address this gap by reducing the need for custom software and rules development with a graphical user interface-driven, highly generalizable approach to concept-level retrieval.

Materials and methods

A ‘learn by example’ approach combines features derived from open-source NLP pipelines with open-source machine learning classifiers to automatically and iteratively evaluate top-performing configurations. The Fourth i2b2/VA Shared Task Challenge''s concept extraction task provided the data sets and metrics used to evaluate performance.

Results

Top F-measure scores for each of the tasks were medical problems (0.83), treatments (0.82), and tests (0.83). Recall lagged precision in all experiments. Precision was near or above 0.90 in all tasks.

Discussion

With no customization for the tasks and less than 5 min of end-user time to configure and launch each experiment, the average F-measure was 0.83, one point behind the mean F-measure of the 22 entrants in the competition. Strong precision scores indicate the potential of applying the approach for more specific clinical information extraction tasks. There was not one best configuration, supporting an iterative approach to model creation.

Conclusion

Acceptable levels of performance can be achieved using fully automated and generalizable approaches to concept-level information extraction. The described implementation and related documentation is available for download.     

Ovarian hemangioma occurring synchronously with contralateral mature cystic teratoma in an 81-year-old patient

Purpose

Ovarian hemangiomas are seen rarely. We present a case of an ovarian hemangioma occurring synchronously with contralateral mature cystic teratoma.

Case history

An 81-year-old woman presented with hypertension and hyponatremia. In ultrasonographic evaluation a pelvic mass was found located at the left ovary. Histologically, a mature cystic teratoma measuring 9.5 × 9 × 8 cm was seen in left ovary. In the right ovary an incidental vascular lesion measuring 3.5 × 1.5 × 1 cm was observed. Final histopathological examination of this lesion demonstrated a hemangioma of cavernous type.

Conclusion

To the best of our knowledge, this is the first ovarian hemangioma case occurring synchronously with contralateral mature cystic teratoma.     

Isolation and structural elucidation of cytotoxic compounds from the root bark of Diospyros quercina (Baill.) endemic to Madagascar

Objective

To isolate and characterize the cytotoxic compounds from Diospyros quercina (Baill.) G.E. Schatz & Lowry (Ebenaceae).

Methods

An ethno-botanical survey was conducted in the south of Madagascar from July to August 2010. Bio-guided fractionation assay was carried out on the root bark of Diospyros quercina, using cytotoxicity bioassay on murine P388 leukemia cell lines as model. The structures of the cytotoxic compounds were elucidated by 1D and 2D NMR spectroscopy and mass spectrometry.

Results

Biological experiments resulted in the isolation of three bioactive pure compounds (named TR-21, TR-22, and TR-23) which exhibited very good in vitro cytotoxic activities with the IC₅₀ values of (0.017 5±0.0060) µg/mL, (0.089±0.005) µg/mL and (1.027±0.070) µg/mL respectively. Thus, they support the claims of traditional healers and suggest the possible correlation between the chemical composition of this plant and its wide use in Malagasy folk medicine to treat cancer.

Conclusions

The ability of isolated compounds in this study to inhibit cell growth may represent a rational explanation for the use of Diospyros quercina root bark in treating cancer by Malagasy traditional healers. Further studies are, therefore, necessary to evaluate the in vivo anti-neoplastic activity of these cytotoxic compounds as effective anticancer drugs.