Ultrasound-guided percutaneous catheter drainage of various types of ruptured amebic liver abscess: a report of 117 cases from a highly endemic zone of India

Abdominal Radiology - To determine the efficacy and safety ultrasound-guided percutaneous catheter drainage (US-PCD) in management of various types of ruptured amebic liver abscess including free...     

Optimizing the Dose of Hydroxyurea Therapy for Patients with β-Thalassemia Intermedia (Hb E-β-thalassemia): A Single Center Study from Eastern India

Over the past 20 years, hydroxyurea (HU) has emerged as an important therapeutic agent to augment Hb F and thus total hemoglobin (Hb) in Hb E [β26(B8)Glu→Lys; HBB: c.79G>A]-β-thalassemia (Hb E-β-thal), albeit used in varying doses with little consensus on its optimal dose. We report the interim analysis findings of a broader study to assess the impact of Comprehensive Thalassemia Care, of which the present report was a part. Sixty-one Hb E-β-thal patients who were transfusion independent or requiring occasional transfusions [β-thal intermedia (β-TI)] were randomized to one of two groups; A (n?=?32) and B (n?=?29) to receive 10 and 20?mg/kg/day HU, respectively. The primary objective of the study was to assess the differences in responses to different doses of HU. Secondary end points were to see the tolerability and safety of HU in different doses. Good response (GR) was defined as a rise of Hb by >1.0?g/dL; intermediate response (IR) as a rise in Hb by 0.6–1.0?g/dL anytime during the study period. No response (NR): rise in Hb by <0.5?g/dL in 12 weeks or drop in Hb level from the previous value. Over a follow-up period of 24 weeks, we had 18 (56.2%) GRs, nine (28.2%) IRs and five (15.6%) NRs, while the number of GRs, IRs and NRs in group B were five (17.2%) 12 (41.4%) and 12 (41.4%), respectively. Adverse effects were more common in group B, making this dose (20?mg/kg/day) of HU more myelo-suppressive than Hb F inducing.     

Jejunojejunal intussusception caused by a jejunal gastrointestinal stromal tumour (GIST)

Introduction

Adult intussusception represents a challenge to the surgeon as it can cause acute, subacute or chronic non-specific obstruction and presents with dubious clinical features.

Case Report

A forty-six-year-old female presented with progressively worsening abdominal pain, mild abdominal distension, anorexia, profuse vomiting and constipation that had begun thirty six hours earlier.

Discussion

Primary or metastatic malignancies are responsible for 14–47% of all small bowel intussusceptions; in the large bowel 66% of cases have malignant aetiology. In contrast, abdominal X-rays display an intussusception as stacked coins or a coiled spring in the upper GI series and cup-shaped defect in contrast enema. The treatment of choice in adult intussusception is always surgical.

Conclusion

Adult intussusception is a rare entity that may present a diagnostic dilemma due to its non-specific symptoms. However, controversy surrounds the need for reduction and extent of surgical resection.     

Disparities in time trends of cervical cancer mortality rates in Brazil

Purpose

This study aimed to correct and describe cervical cancer mortality rates and trends by regions and age-groups in Brazil. It may help planning and implementing policies for cervical cancer control.

Methods

Data from 2003 to 2012 were accessed through the centralized national mortality database. Correction of the age-specific mortality rates was done by proportional redistribution of ill-defined causes of death and deaths coded as ‘uterine, part unspecified’. Annual percentage change (APC) was obtained by trend analysis (Joinpoint regression).

Results

In the 10-year period, cancer and ill-defined causes corresponded, respectively, to 18.9 and 10.8 % of all deaths (except injuries). The proportion of ill-defined causes was reduced by more than a half in the period. The age-standardized cervical cancer mortality rate was 7.2 per 100,000 women-years after correction. The total increase in rates after corrections was 50.5 %. A significant decreasing trend in rates was observed at the national level (APC = ?0.17, p < 0.001). North was the only region that did not show a decreasing significant trend (APC + 0.07, p = 0.28). Decreasing trends were restricted to age-groups over 40 years.

Conclusions

A consistent decreasing trend of cervical cancer mortality rates in Brazil from 2003 to 2012 was observed, although this was not consistent in all regions and restricted to older age-groups. Quality of data needs to be improved. Cancer control policies may consider the differences in access to care and the characteristics of regions to improve their efficiency.

     

Correlation between central venous pressure and peripheral venous pressure with passive leg raise in patients on mechanical ventilation

Background:

Central venous pressure (CVP) assesses the volume status of patients. However, this technique is not without complications. We, therefore, measured peripheral venous pressure (PVP) to see whether it can replace CVP.

Aims:

To evaluate the correlation and agreement between CVP and PVP after passive leg raise (PLR) in critically ill patients on mechanical ventilation.

Setting and Design:

Prospective observational study in Intensive Care Unit.

Methods:

Fifty critically ill patients on mechanical ventilation were included in the study. CVP and PVP measurements were taken using a water column manometer. Measurements were taken in the supine position and subsequently after a PLR of 45°.

Statistical Analysis:

Pearson''s correlation and Bland–Altman''s analysis.

Results:

This study showed a fair correlation between CVP and PVP after a PLR of 45° (correlation coefficient, r = 0.479; P = 0.0004) when the CVP was <10 cmH₂O. However, the correlation was good when the CVP was >10 cmH₂O. Bland–Altman analysis showed 95% limits of agreement to be −2.912–9.472.

Conclusion:

PVP can replace CVP for guiding fluid therapy in critically ill patients.     

Establishment of age-specified bone mineral density reference range for Indian females using dual-energy X-ray absorptiometry

We undertook this study to establish age-specified bone mineral density (BMD) reference range for Indian females using dual-energy X-ray absorptiometry. BMD at multiple skeletal sites was measured in 2034 healthy women aged 18--85yr. The effect of anthropometry and biochemical parameters on BMD was determined. Peak BMD was observed between 30 and 35yr at the hip, lumbar spine, and radius. Significant positive correlation of height and weight with BMD was observed at 33% radius, femur neck, and lumbar spine, whereas significant negative correlation was seen between serum alkaline phosphatase (ALP) and serum parathyroid hormone levels with BMD at aforementioned sites. On multivariate regression analysis, age, weight, and serum ALP were the most consistent contributors to variance in the BMD. Compared with age-matched US females, BMD of lumbar spine was significantly lower for our subjects in all age groups. Prevalence of osteoporosis among women aged older than 50yr was significantly higher based on Caucasian T-scores as opposed to using peak BMD/standard deviation values from the population under review at lumbar spine but not at femoral neck.     

Effect of freeze drying and oven drying on antioxidant properties of fresh wheatgrass

The effects of freeze drying and hot air drying on total phenolics, total flavonoids and antioxidant properties of flour from seven-day-old fresh wheatgrass (Triticum aestivum L.) were investigated. In the quantitative analysis of antioxidative components, fresh wheatgrass samples had the highest amount of ascorbic acid and chlorophyll, but the lowest amount of total flavonoids and phenolics. In the analysis of ferric-reducing antioxidant power assay (FRAP), ethanolic extract from freeze-dried wheatgrass gave the highest value, while the α-tocopherol gave the lowest value. In the analysis of 2,2-diphenyl-1-picrylhydrazyl scavenging ability, freeze-dried wheatgrass samples exhibited the highest activity among the three samples.