Friday, 15 December 2017

Frequency of Congenital Heart Defects in Indian Children with Down Syndrome


Congenital Heart Diseases (CHD) are commonly associated with Down Syndrome (DS) infants. Our study aimed at determining the occurrence and pattern of CHD in association with DS among patients in Indian subjects. A total of 60 patients with clinical features suggestive of DS were recruited. Echocardiography, standard karyotype and QF-PCR (Quantitative – Flourescent PCR) studies were performed in all patients in order to confirm DS. CHDs were detected in the 50% of children with DS. The commonest type of CHD reported in Indian subjects was atrioventricular septal defect (50%). The second most type of CHD present was ventricular septal defect (26.6%). Other type of CHD included in our study was atrial septal defect, tetralogy of fallot and patent ductus arteriosus with the frequency of 10 %, 6.6 % and 6.6% respectively. Our findings showed that CHDs are common in Indian DS children. These results suggest that a routine echocardiography should be mandatory in DS patients.

 Down Syndrome (DS) or trisomy 21 is a chromosomal disorder associated with a varied combination of morphological and structural birth defects. These defects include congenital mental disability, hypotonia, characteristic body features, congenital heart defects, Hirschsprung’s diseases and others. The frequency and severity of these morphological and functional defects vary significantly among affected individuals. DS affects about one in 700 live births.
Congenital heart defect disorder or CHD is a common defect among newborn infants [3] which can be caused by environmental or genetic factors. About 50% of babies with DS are born with CHD, which is a much higher percentage compared to the number of children without DS who are born with CHD which is approximately 1%. The most common CHD seen in infants with DS is an Atrioventricular Septal Defect (AVSD), or AV canal. Other heart defects seen in infants with DS include Ventricular Septal Defects (VSD), Atrial Septal Defects (ASD), Tetralogy of Ffallot (TOF) and Patent Ductus Arteriosus (PDA). However, the exact etiology of CHD in DS remains poorly understood. Few decades ago the frequency of CHD in DS was estimated to be approximately 20%, but now with the use of better diagnostic tool, the frequency estimated has increased to 50%. The most common CHD in the western literature is atrioventricular septal defects.

This hospital based descriptive study was conducted in department of Genetics, SGPGIMS, Lucknow Uttar Pradesh and department of Pediatrics, Post Graduate Institute of Medical Education and Research, PGIMER, Chandigarh. Total sixty DS children with age 0-15 years were included in this study. All patients were diagnosed based on 2- dimensional echocardiography for CHD and molecularly confirmed for DS using karyotyping in combination with QF-PCR. Exclusion criteria were race other than Indian. All the participants were of Indian the same ethnic origin and this study was approved by the Institutional Ethics Committee of Sanjay Gandhi Post Graduate Institute of Medical Sciences, SGPGI, Lucknow, and Uttar Pradesh. Presence of CHD and type of CHD were recorded as potential risk factors of DS. DS infants were as categorized under two groups: CHD and non CHD.

Thursday, 14 December 2017

Risk Factors of Surgical Recurrence after Resection for Crohn’s Disease

                                                      Austin Journal of Gastroenterology

Objective: The surgery is required in more than 80% of patients with Crohn’s disease. Crohn’s disease is associated with high rates of postoperative recurrence. The aim of the study was to identify, the risk factors of postoperative ‘surgical recurrence’ after the first resection for Crohn’s disease.
Methodology: We report a retrospective study from January 1998 to September 2010 that studied 226 patients originated only from Tunisia (in North Africa), operated on for MC. We had been interested to the risk factor of surgical recurrence of Crohn’s disease.
Results: Mean age was 33 years. The average time between the onset of the disease and the surgical procedure was 31 months. The diagnosis of CD was established preoperatively in 213 patients (94%). The diagnosis was made intraoperatively because of an acute complication in 5 cases (2.2%) and postoperatively in 8 cases (3.5%). The most common location was the ileocecal junction in 184 cases (81.4%). The most common type of lesion was the mixed form (stricture and fistula) in 123 cases (54.4%). Operative mortality was 0.04% (n=1). Specific morbidity was 8.4% (n=19). In long term, a surgical recurrence was noted in 18 patients (8%). In multivariate analysis, independent risk factors for recurrence were: smoking (p=0.012, ORs=3.57) and post-operative medical treatment (p=0.05, ORs=2.6).
Conclusion: Our series is unique for a lower rate of the postoperative recurrence (8%). The two risk factors of recurrence are smoking and the necessity of postoperative medical prophylaxis.
The surgery is required in more than 80% of patients with Crohn’s disease (CD) [1]. The aim of surgery is to treat complicated lesions [2]. The most important principle of the surgery is to perform an intestinal resection as limited as possible. Crohn’s disease is associated with high rates of postoperative recurrence. At 10 years after surgery, 75% of patients suffer recurrence and 45% of these require re-intervention. The aim of the study was to identify, the risk factors of postoperative ‘surgical recurrence’ after the first resection for Crohn’s disease.

This is a retrospective study, with prospective collection of data, conducted from January 1998 to September 2010, which included all patients undergoing surgery for primary CD. All patients born and living in Tunisia in North Africa. The diagnosis of CD was confirmed in all cases by histological examination of endoscopic biopsies or specimen after bowel resection. We excluded from this study, patients initially operated in another center and patients operated on for isolated anoperineal lesions of CD. The management was multidisciplinary and standardized for all patients.

Wednesday, 13 December 2017

Effect of Ammonium Sulphate Foliar Spray on Grain Yield and Yield Quality of Canola


The experiment entitle “Effect of Ammonium Sulphate Foliar Spray on Grain Yield And Yield Quality of Canola” was conducted at the Palatoo Research farm Department of Agronomy, Amir Muhammad Khan Campus, Mardan during rabi season 2014-15. The treatments consist of Ammonium Sulphate (AS) 1%, 0.2%, 0.3% solution and water spray as control. The experiment layed out in randomized complete block design with four replications. The results indicated that application of 1% AS improved grain yield 3177 (control) to 3423 (treated), oil content 42.3% (control) to 45.7% (treated), gluccosinulates 65.2 micro mol gm-1 (control) to 70.1 micro mol gm-1 (treated), protein content 23.1% (control) to 23.6% (treated), grain Sulphur % 0.29 (control) to 0.32 (treated) and grain nitrogen %3.35 (control) to 3.89% of (treated). The application of AS 0.2% produced grain yield (3342 kg ha-1) oil content (43.2%) gluccosinulates (62.8micro mol gm-1) protein content (23.4%) grain Sulphur (0.30%) and grain nitrogen (3.11%). While the application of AS 0.3% produced grain yield (3245 kg ha-1) oil content (44.2%) gluccosinulates (67.1 micro mol gm-1) protein content (2.5%) grain Sulphur (0.31%) and grain nitrogen (3.0%). Therefore on the basis of this research at 1% AS is suggested for application on canola to improve its grain yield and yielding quality components.

 Rapeseed (Brassica napus L.) belongs to the Cruciferae family the common species are Nigra, Carinata, juncea, oleracea and compestries. Rapeseed or mustard was grown from 300 Bc in Indus valley of Pakistan as a fodder crop. Rapeseed and mustard are traditional oil seed crops of Pakistan are grown in large area of four provinces of country. Canola was introduced in Pakistan during 1995 for general cultivation to replace traditional oilseed crops like rapes and mustards because of its low erucic acid contents and high yielding capacity. During 2011-12 in Pakistan the Canola crop was cultivated 14700 ha with the production of 7000 tones, while Khyber Pakhtunkhwa the area under cultivation was 1300 ha with a total production of 1800 tones.

Like all other crops, growth, developmental process and grain yield of canola depends upon biotic and a biotic factors. Sulfur is the fourth major plant nutrient after nitrogen, phosphorus and potassium. It is essential for synthesis of the amino acids like cystine and methionine, a component of vitamin A and activates certain enzyme systems in plants. Edible oil is one of the basic requirements of our daily diet. Pakistan is suffering from acute deficiency in edible oil because of its increased consumption. The total availability of edible oil was 2.821 million tons. Local production of edible oil stood at 0.68 million tons, which is 24 percent of the total availability in the country. Sulphur has been reported to influence productivity of oil seed.

Tuesday, 12 December 2017

Fatal Pulmonary Tumour Thrombotic Microangiopathy (PTTM) Associated with Signet Ring Cell Carcinoma of Colon: An Autopsy Diagnosis

Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare clinicopathological entity in which the tumor cells embolize to the pulmonary vasculature leading to fibro cellular intimal thickening and arteriolar occlusion by cellular intimal proliferation. Sub-acute respiratory failure, pulmonary hypertension, right sided heart failure and sudden death may be seen due to consequences of stenosis of blood vessels.
We describe a case of a 23 year old man who presented with alleged history of found unconscious and declared brought death. He was clinically diagnosed as refectory sepsis with ventilator associated pneumonia with acute kidney injury. Past history revealed Crohn’s disease and treatment with Azathioprine and prednisolone. Mucicarmine was positive in colonic tumor as well as in pulmonary tumor cell emboli with recanalization and intimal fibro cellular proliferation of small arteries. A postmortem diagnosis of poorly differentiated signet ring cell carcinoma of colon with PTTM was made based on autopsy results.
Unfortunately, PTTM is difficult to diagnose and is mostly a post mortem diagnosis with an extremely poor prognosis. Pulmonary hypertension due to metastatic tumor emboli should be included in the differential diagnosis of various causes of dyspnea in patients with cancer.
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare clinicopathological entity in which the tumor cells embolize, organize and recanalize to the pulmonary vasculature leading to fibro cellular intimal thickening and vessel stenosis. Sub-acute respiratory failure, pulmonary hypertension, right sided heart failure and sudden death may be seen due to consequences of stenosis of blood vessels caused by PTTM. In this report, we describe a rare case of PTTM associated with metastatic colon carcinoma diagnosed on postmortem examination of a young man. We also aim to review the literature related to PTTM and associated malignancies and how they were diagnosed and managed.

Monday, 11 December 2017

The Comparison of Muscle Timing between Athletes with and without Chronic Ankle Instability during Lateral Jump Landing


Most studies have investigated peroneal reaction time in relevant conditions of unexpected inversion perturbation occurring. The need to conduct more functional and dynamic testing that closely mimics athletic performances has been emerged.The aim of present study was to compare premotor time and motor time of leg muscles between athletes with and without chronic ankle instability during landing phase of a lateral jump condition.Twelve athletes with self-reported unilateral chronic ankle instability and 12 matched controls participated in the study. Participants performed lateral jump landing test during a relatively simple dynamic choice reaction task.An electromyography device synchronized with a force plate collected data during the landing phase of lateral jump. Premotor time, motor time and reaction time of leg muscles were recorded and group differences were assessed.
Mean premotor time values for peroneus longus and tibialis anterior muscles were significantly (P=0.000, P= 0.035 respectively) greater in chronic ankle instability patients compared to controls. There was astatistically significant (p=0 .001, P= 0.014 respectively) decrease in motor time measures for peroneus longus and brevis muscles in chronic ankle instability group compared to control group. There was no statistically significant difference in reaction time between the 2 groups.This study found muscle timing deficits in injured ankles of athletes with chronic ankle instability compared to healthy ones. The greater premotor time delay of peroneus longus and tibialis anterior muscles demonstrated in subjects with ankle instability in compared to healthy athletes should be taken in to consideration during assessment and rehabilitation programs.
Ankle sprains are one of the most common injuries affecting athletes. Many ankle injuries are found in sports that require jumping and landing such as basketball, volleyball and soccer. Ankle sprains account for up to 25% of all lost time from participation in sport competitions. People who experience an ankle sprain are at risk of developing Chronic Ankle Instability (CAI) which is characterized by subjective, repeated episodes of giving way after an initial ankle sprain. It has been estimated that up to 80% of athletes experience a recurrent sprain. Symptoms of residual instability represent in 20-40% of patients and this can lead to osteoarthritis in long term. Proprioception, muscle strength, muscle reaction time, and postural control are the factors contributing to impaired neuromuscular control that is believed to be the main cause of ankle instability development.

Friday, 8 December 2017

Emergency Dialysis in End-Stage Renal Disease: Incidence and Characteristics in La Paz, Baja California Sur

According to international guidelines of Kidney Disease: Improving Global Outcomes (KDIGO, 2012); chronic renal failure (CRF) is defined as those abnormalities of kidney structure or function, present for more than 3 months with implications for health. CRF is classified according to cause, category of glomerular filtration rate (GFR) and category of albuminuria. The estimated prevalence of CRF is 16.8% worldwide. CRF can progress to end-stage renal disease (ESRD), which requires dialysis or transplantation. However, many patients cannot undergo such therapies because of its high cost [2- 3].Complications of CRF include dialytic emergency, anemia, renal osteodystrophy and malnutrition, among others.
CRF is a highly prevalent pathology that affects people of all races, nationalities, age, gender and economic level. Low socioeconomic status and poor access to health services contribute to inequality in health care and exacerbate negative effects of genetic or biological predisposition [5-6]. It is precisely the people with little or no access to health services who are at greater risk for complications of CRF.
According to annual report of the United States Renal Data System, main causes of end-stage renal failure in patients with CRF are diabetes (153 cases per million inhabitants in 2009), arterial hypertension (99 cases per million inhabitants) and glomerulonephritis (23 cases per million inhabitants). Cardiovascular disease is also an important cause; however, about 28% of patients with clinically significant CRF (stage 3 or higher) are not diabetic or hypertensive, especially those older than 65 years. In developing countries, diabetes and hypertension are currently the leading causes of CRF with a prevalence of 30% and 21% respectively, but glomerulonephritis and CRF of unknown origin are responsible for a greater proportion of ESRD, especially in young patients.
In Mexico, CRF is one of main causes of morbidity and mortality and one of main causes of hospitalization in emergency departments. CRF is considered a catastrophic disease due to increasing number of cases, high investment costs, limited infrastructure and human resources, late detection and high morbidity and mortality rates in substitution programs. In Mexico, prevalence and incidence of patients with CRF is unknown and the precise number of patients in any of its stages, age groups and gender most affected is unknown. An incidence of 377 cases per million inhabitants and a prevalence of 1,142 per million is estimated. In Mexico there are about 52,000 patients on dialysis, of which 80% are treated at the Mexican Social Security Institute (IMSS).

Thursday, 7 December 2017

Risk of Lactic Acidosis in Diabetic Patients Taking Metformin and Who Receive Intravascular Iodinated Contrast Media

Due to thelarge number of patients who develop diabetes mellitus type 2 and the tendency to use radiological methods to avoid invasive procedures, it is becoming increasingly frequent to find patients undergoing metformin treatments who are being given intravascular iodinated contrast media. Traditionally, the fear that this can be linked to lactic acidosis has always existed, despite no proven evidence to support this theory.

The prevalence and incidence rate of diabetes mellitus type 2 is currently increasing; in most patients, the disease’s treatment is still based on the administering of metformin, along with a change of life style. Also, the number of patients who undergo radiological examinations, in which some form of intravascular iodinated contrast media is used, is increasing every day. Traditionally, metformin was withdrawn from those patients who needed to undergo studies involving intravascular iodinated contrast media due to the risk of developing lactic acidosis which, although not very frequent, has a very high mortality rate (40%). However, the evidence supporting this is based on isolated cases which have been researched using heterogeneous studies.

Intravascular iodinated contrast media are not a stand-alone risk factor of lactic acidosis in patients that take metformin, but rather they become relevant when other underlying kidney disorders are also present. Taking this into account, we can establish a causal link because the use of intravascular iodinated contrast media does suppose a risk of developing kidney failure; this risk can be stratified depending on each patient’s characteristics. According to this there is a possibility of developing contrast-induced nephropathy. A set of variables were established and given a value; according to the total sum, the risk of developing a nephropathy can be calculated. The variables were: systolic blood pressure below 80mmHg, intra-aortic balloon pump, grade 3-4 heart failure or a history of acute lung edema, being over 75 years of age, packed cell volume below 39% in men or below 36% in women, diabetes mellitus, contrast volume and glomerular filtration (which greatly affects the final assessment).