Thursday, 3 August 2017

Medical Journal- June issue 2017

Medical Journal: Published volume-3, Issue-6, June 2017 with ad publications

Effects of Platelet Rich Plasma in Treatment of Androgenetic Alopecia (AGA): An Interventional Study

Abstract— Androgenetic alopecia (AGA) is a common condition having severe psychosocial implications. Numerous modalities of treatment are there but none is satisfactory both to the patient and the treating physician. This present study was carried out on 50 patients of AGA aged between 20 to 50 years to find out the effect of PRP with micro needling on AGA. These selected cases were treated by activation of the procedure site (scalp) by micro needling technique and application of platelet rich plasma on the activated site. A total of 6 such sittings were given to each patient at interval of 30 days each, over a total period of 6 months. Macro photographs were taken at baseline and after 6 months by 2 independent observers who rated those using of standardized seven-point rating scale of clinical change. In this study, 24% patients perceived stoppage of hair fall, 68% patients noticed reduction in hair fall, 6% of the patients perceived no change in hair fall and remaining 2% patients perceived increased hair fall after last visit with minimal or no side effects. So over all 92% patients had noticed some clinical improvement in their condition. So it was concluded that PRP with micro needling is an effective combination in treating AGA. This may be because micro needling has its own action and it would also help in promoting penetration of PRP but the level of evidence of this fact as available published data is low. This demands further studies to gain more evidence before it is used more extensively.

Keyword: Androgenetic Alopecia(AGA), Platelet Rich Plasma (PRP), Micro Needling.

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Seropositivity and seasonal trend of dengue cases in Jaipur (Rajasthan), Western India (2010-2016)

Abstract— Dengue virus infection has emerged as a notable public health problem in recent decades in terms of its increased transmission to urban and semi urban areas. Study was conducted on samples of suspected dengue cases with the aim to find out seropositivity and seasonal pattern of dengue, which is important for effective control of a disease. For this study, samples were received in department of Microbiology, SMS Hospital Jaipur (Rajasthan) for Dengue IgM & IgG during 1st January 2010 to 31st December 2016. Blood samples collected in plain vials were tested for IgM and IgG antibodies for dengue virus serotype DENV-1, 2, 3 and 4 by a solid phase in vitro immunochromatographic test. It was observed that out of 86,538 serum samples tested, 5011 (5.76 %) were found to be positive for dengue infection. Among these seven years, maximum numbers of dengue cases were identified in year 2013(33.12%). Seropositivity ranged from 0.73% in year 2016 to 13.1% in year 2010. Likewise when seasonal trend was explored it was found that 83.87% of total cases were found from September to November with peak in October. In rest of months around 1% of cases were there in each month except few more cases in August and December i.e. 4.23% and 6.25% respectively. It can be concluded that Dengue has become an endemic disease in this area. Occurrence of most of the cases in post-monsoon period indicates a need for acceleration of vector control programme prior to monsoon.

Keywords: Dengue, Seropositivity, Seasonal Trends

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Gum Hypertrophy- Warning Sign of acute myeloblastic leukemia (AML M2): A Case Report

Abstract— Many systemic diseases are early indicated by oral manifestations. Among such systemic diseases Leukemia is one which shows characteristic oral manifestations. Acute myeloid leukemia (AML) is characterized by maturation arrest of myeloid cells which leads to increase in number of myeloblasts in the bone marrow and hemopoietic insufficiency. Patients with AML in general may present with a wide variety of (atypical) symptoms, which may range from minor symptoms to life-threatening complications. Gingival hyperplasia is most commonly seen with the AML subtypes acute monocytic leukemia (M5) and acute myelomonocytic leukemia (M4). Here, an unusual case of diffuse gum hypertrophy in a 25 year old Asian female which led to laboratory studies yielding a rapid and relatively early diagnosis of acute myeloblastic leukemia (AML M2) was reported. This case emphasizes that clinicians and dentists should be well acquainted with the oral manifestations of systemic diseases and stresses the role of gingival hypertrophy as a diagnostic indicator in leukemia.

Keywords: Gingival enlargement, Leukemia, Acute Diffuse Myeloblastic.

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Outcome assessment of composite Oro-Mandibular Defect Reconstruction with Double Skin Paddle Free Fibula Osteocutaneous Flap

Abstract— Free fibular flap is the most favored free flap for composite defects of oro-mandibular region. Composite defects involving mucosa, mandible and skin often require two free flaps for the reconstruction. A technique of harvesting two separate cutaneous paddles of free fibular flap each based on a definite peroneal artery perforator was presented in this study. Reconstruction of composite oro-mandibular defect was done with two independent cutaneous paddles (proximal skin paddle based on musculo-cutaneous perforator and distal skin paddle based on septo-cutaneous perforator) in 12 patients. Post operative outcome was good, with 11 cases having no loss of skin paddle. There was an outer skin paddle necrosis in one patient for which cover was given with pectoralis major myocutanous flap. A double paddle free fibula flap can be used to reconstruct composite defects providing inner lining as well as skin cover with good flap success rates and better functional and aesthetic patient outcomes, thus avoiding an additional free or regional flap morbidity and decreased operative time.

Keywords: Oro-Mandibular Reconstruction, Free Fibula Flap.

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Fetomaternal Outcome & Complications of Pregnancy with Fibroids

Abstract—Fibroid (myoma) is the most common benign tumors of the uterus. Chances of complications are approximately 10-40% in the presence of fibroids. This study was aimed to assess the maternal & fetal outcome and complications in pregnancy with fibroids. It was conducted on 20 pregnant women with fibroid. Routine basic investigations were done for all subjects included in the study. Ultrasonography was done at booking visit and during subsequent visits to assess changes in size of the fibroid and associated complications. It was found that Fibroids were more frequent in multigravidae (65%) than primigravidae (35%). Majoriy (70%) were diagnosed as having fibroid during routine antenatal visits and 30% were known case of fibroid prior to conception. Twenty five women had pain, 10% had threatened preterm labor, 15% had spontaneous miscarriage, 30% had anemia and placenta previa was diagnosed in 15% women. Majority (60%) had Lower segment cesarean section (LSCS) and only 40% had vaginal delivery. Though many fibroids are asymptomatic but fibroids during pregnancy can lead to complications during the antepartum, intrapartum, and postpartum period, so they need proper follow-ups and repeated assessment. Overall prognosis depends on their location and size

Keywords: Fibroid, Myoma, Uterus Tumour, Fetomaternal outcome

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Hemimandiblectomy with and without intermaxillary fixation: A Quincy experiment

Abstract— Oral malignancy involving mandible, floor of mouth, tongue, and also palate when treating surgically often requires resection of mandible. Resection of mandible leads to loss of mandibular continuity, deviation of mandible towards resected site, altered mandibular movements, difficulty in swallowing, and impaired speech. Management of this type of mandibular defects without bony reconstruction is complex. Hemimandibulectomy with intermaxillary fixation prevent mandibular deviation and malocclusion.

Keywords: Intermaxillary Fixation, Hemimandibulectomy, Mandibular Deviation.

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Thanatophoric Dysplasia Type I with Bilateral corneal opacities: A Case Report

Abstract— Thanatophoric dysplasia is the most common form of lethal skeletal dysplasia, diagnosed by its characteristic clinical and radiographic features. It has two types distinguished by radiological findings. Specific ocular features associated with Thanatophoric dysplasia have not known to be reported. A baby with clinical findings of a large head, short stature , low set ears, short and curved limbs, small thorax, bilateral corneal opacities and radiographs showing short and curved long bones, femurs like telephone- receiver look, H- shaped vertebrae, small iliac wings was reported. This rare case was thoroughly examined and investigated which came out to be a case of Thanatophoric Dysplasia Type I with corneal opacities. So when a case of Thanatophoric dysplasia Type 1 with bilateral corneal opacities was attended at pediatric department, a detailed report was prepared to publish such a rare case.

Keywords: Skeletal Dysplasia, Corneal Opacities.

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Anthropometric predictors for sexual dimorphism of skulls: A Comparative study

Abstract— Quantitative morphometric measurements with advanced analytical methods are emerging as reliable methods for sex differentiation of skeletal remnants. Aim of present study was to determine the difference in morphometric measurements in male and female skull and to determine the independents predictors and accuracy for sex differentiation using discriminant function analysis. A comparative observational study was conducted using 44 skull of known sex including 24skulls of males and 20 skulls of females. Various morphometric parameters are measured and analyzed using univariate, multivariate and discriminant function analysis. Cranial AP length, Bi Zygomatic diameter, Nasal Height, Nasal width and Mastoid length were found to be significantly higher in male skull. Discriminant function analysis predicted correctly the sex of skull with 79.5% accuracy. Morphometric measurement of cranium can be developed as objective method of sex determination with higher accuracy and repeatability and further enhanced by advanced statistical method like discriminant function analysis.

Keyword: Sexual Dimorphism, Morphometric Measurements, Skull.

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Acute Undifferentiated Febrile Illness (AUFI) in adult hospitalized patients: An experience from a tertiary care hospital of western Uttar Pradesh region from North India

Abstract— Acute undifferentiated febrile illness (AUFI) is a common occurrence in low and middle income groups countries like India and constitutes heavy burden on healthcare industry especially from month of June to September. AUFI includes various diseases which are very difficult to differentiate. So this study was conducted on 504 AUFI cases to present an etiological profile of these AUFI cases. It was found that among these 504 AUFI cases, 6.54% were Malaria, 15% Typhoid, 14% Dengue, 3.17% Chickenguniya, 4.56% were mixed infections and 60.7% were undiagnosed.

Keyword: Acute Undifferentiated Febrile Illness (AUFI), Malaria, Undiagnosed Undifferentiated Febrile Illness (UUFI), Dengue, Chikungunia.

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Symptom Score Questionnaire for Nasolacrimal Duct Obstruction (NLDO) in Adults – A novel tool to assess impact on quality of life after Endoscopic Dacryocystorhinostomy

Abstract— Dacryocystorhinostomy (DCR) is a commonly applied surgical technique to treat nasolacrimal pathway obstruction. However, no disease-specific tools to assess the symptoms and the subjective outcome after DCR have been established. A specific Nasolacrimal Duct Obstruction Symptom Score (NLDO-SS) questionnaire was develop to evaluate the outcome and tested it in a prospective. Primary endoscopic dacryocystorhinostomy (EN-DCR) procedures were performed in 60 patients during 2013-2014. Preoperatively and during the three follow-up (3 month, 6 months and 12 months ) visits, the patients were asked to fill the NLDO-SS along with Glasgow Benefit Inventory (GBI) questionnaire. The success rate of EN-DCR was 91.67%. EN-DCR resulted in a significant reduction in all of the eight symptoms scores of the NLDO-S. The GBI scores indicated a benefit at 3 months and more benefit at 6 months, but no further improvement was found between 6 and 12 months. The correlation between the total GBI and NLDO-SS was significant. EN-DCR improves the quality of life as measured by the GBI. The NLDO-SS correlated with the GBI and gave more information about the benefits after EN-DCR than GBI alone. The NLDO-SS proved to be an effective tool to evaluate lacrimal obstructions and ENDCR benefits.

Keywords: Endoscopic Dacryocystorhinostomy, Nasolacrimal Duct Obstruction Symptom Score (NLDO-SS), Glasgow Benefit Inventory (GBI), Quality Of Life.

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Cytomorphometric Study of Effect of Tobacco Smoking on Buccal Mucosa: A Case control study

Abstract—Tobacco smoking is associated with increasing risk of oropharyngeal cancer. Oral cytology, mainly based on the presence of nuclear or cytoplasmic alterations, can easily be performed to detect cancer at an early stage and provides a quantitative technique. The objective of the present study was to assess the effect of smoking on buccal mucosa using cytomorphometry. This case control study included 36 smoker subjects and 36 non-smoker controls between the age of 30 and 70 years. Buccal epithelial cells were collected with a brush and fixed smears were stained with Papanicolaou stain and cytomorphometric analysis performed using image analysis software (Image J v 1.47). Smoker group was found to have higher mean nuclear diameter (MND), lower in mean Cellular diameter (MCD), and higher nucleo-cytoplasmic ratio as compared to normal subjects. This change in nuclear parameters indicates smoking-related cellular adaptation, leading to progression towards dysplasia. Cytomorphometric changes could prove to be the earliest indicators of these cellular alterations.

Keywords: Cytomorphometry, Smoker, Buccal Mucosa.

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Effect of Caudal Epidural Injection for management of Lumbar Spinal Stenosis: A randomized controlled Trial

Abstract—Chronic low back pain (LBP) is a common cause of morbidity and work absenteeism worldwide. This hospital based randomized, controlled, interventional study is conducted to assess the effectiveness of caudal epidural steroid injection in lumbar spinal stenosis. Study subjects were chronic low back pain patients attending at department of Physical Medicine and Rehabilitation (PMR), Sawai Man Singh Hospital, Jaipur (Rajasthan) India. For study purpose, 60 LBP cases were taken in Study group and 60 cases were taken for control group. To compare the effect between conservative treatment alone and added with caudal epidural injection of steroid plus saline in lumbar spinal stenosis, in study group, a mixture of MPA (3mg/kg body wt.) plus 16 ml of normal saline was injected in epidural space along with conservative treatment and in control group only conservative treatment was given. It was observed in this study that patient had more significant improvement in low back pain, leg pain, walking distance and functional activity after caudal epidural block in the study group than control group for a period of 3-6 months. So it was concluded that when conservative treatments were combined with interventional methods in form of caudal epidural steroid injection the amount of relief gets augmented as compared to the conservative treatment alone resulting in the patient benefiting in terms of much better symptom control and pain relief, improvement in anxiety, depression and activity limitations and quality of life.

Keywords: Chronic low back pain (LBP), Methylprednisolone Acetate.

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