iosr-JDMS   Volume-7 ~ Issue-3

Abstract: Background: In Breast cancer there is paradigm shift towards its prevention and early detection. Self breast examination and clinical breast examination plays an important role in early detection. Currently a combination of three tests, i.e. clinical examination, radiological imaging (mammography, ultrasonography) and pathology called as triple assessment test is used as Gold standard in diagnosing all palpable breast lumps. Together they give sensitivity of 99%. The triple assessment is taken as positive if any of the three components is positive and negative only if all of its components are negative for malignancy. Materials And Methods This study was conducted in the Department of Surgery, Rama Medical College Kanpur over a period of 4 years from March 2009 to Feb.2013. A total of 400 patients with a breast lump were selected irrespective of age. A detailed history, thorough clinical examination, radiological imaging and fine-needle aspiration cytology (FNAC) were used as diagnostic tools for screening of the patients. The aim of this study was to evaluate accuracy of triple assessment in the early detection of breast carcinoma. Results The sensitivity and specificity of all the modalities used in triple assessment when combined together was100% and 99.3%, respectively. The concordance for the triple assessment was 99.3%, positive predictive value was 93.3%, negative predictive value was 100%, sensitivity was100% and specificity was 99.3%. p value was significant (0.000). Conclusion Triple assessment is a very useful diagnostic tool to evaluate patients with breast lumps and to detect patients with breast cancers with an overall accuracy of 99.3%.

Keywords: Clinical examination, Carcinoma, Fine-needle aspiration cytology,Mammography, Ultrasonography,

[1] Bland KI, Beenken S, Copeland EM III (2005) The Breast.Schwartz‟s PrincipSurg 16:454

[2] Iglehart JD, Kaelin CM (2004) Diseases of the breast. In:Sabiston Text Book of Surgery; 17th edition, Vol. 1; pp 877

[3] Yang WT, Mok CO, King W, Tang, Metreweli C (1996)Role of high frequency ultrasonography in the evaluationof p3lpable breast masses in Chinese women: Alternative tomammography. J Ultrasound Med 15(9):637–644

[4] Pande AR, Lohani B, Sayami P, Pradhan (2003) Predictivevalue of ultrasonography in the diagnosis of palpable breastIndian J Surg (March–April 2010) 72:97–103 103123lump. Kathmandu Univ Med J (KUMJ) 1(2):78–84

[5] Shetty MK, Shah YP, Sharman RS (2003) Prospective evaluationof the value of combined mammographic and Sonographicassessment in patients with palpable abnormalities.J Ultrasound Med 22(3):263–268, quiz 2670

[6] Martelli G, Pilotti S, Coopmans de Yoldi G, ViganottiG,Fariselli G, Lepera P, Moglia D (1990) Diagnostic efficacy ofphysical examination, mammography, fine needle aspirationcytology (Triple test) in solid breast lumps: An analysis of1708 consecutive cases. Tumouri 76(5):476–479

[7] Kaufman Z, Shpitz B, Shapiro M, Rona R, Lew S, DinbarA(1994) Triple approach in the diagnosis of dominant breastmasses: Combined physical examination, mammography,and fine-needle aspiration. J SurgOncol 56(4):254–257

Abstract: Sputum microscopy, the most commonly practiced tuberculosis (TB) diagnostic test is less sensitive in immunocompromised patients due to low bacillary load.The study was carried out in a tertiary care general hospital during 2010-12 in Mysore, Karnataka, to diagnose smear negative TB in HIV patients by culture technique.Of416 HIV patients, 162 patients with features of pulmonary/extrapulmonary TB but smear negative were included in the study.Sputum, stool, blood and other relavent clinical samplese except blood were processed as per standard protocol. The blood collected with sodium citrate was processed by lysiscentrifugation .All samples were inoculated onto Lowstein Jensen slants and incubated at 370c for 6 to 8 weeks.Of 162 HIV patients, 67(41%) were found to have TB. Extrapulmonary TB (25%) was more common than pulmonary TB (13%). Mycobacteria were recovered in 76 samples (26 sputum, 12 stool, 18 blood, 7 pleural fluid, 1 CSF, 9 FNAC, 1 ascitic fluid, 1pus ,1 ear discharge). M.tuberculosis (95%) was the predominant species isolated followed by M.avium complex (5%).Most HIV patients with TB are left undiagnosed for reasons of no advanced/high cost techniques in resource constrained settings. Thus culture could be used as a tool in diagnosing smear negative TB.

Keywords: Culture, HIV, Smear negative, Tuberculosis.

[1]. Source: HIV and Hepatitis C Annual Update. Management of Tuberculosis in HIV-Infected Patients. 2012. [cited 2012 Dec 31]. Available from http://www.clinicaloptions.com/HIV/Annual%20Updates/2012%20Annual%20Update/Modules/TB_HIV_Management.aspx

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Abstract: In a prospective study we invistigated internal derangement of knee (IDK) with High resolution ultrasound (HRUS). Aim was to determine effectiveness of ultrasound in diagnosing IDK and to compare with Arthroscopy. Ultrasound showed good sensitivity (91.3%) and specificity (90.6% ) and the figures were comparable toarthroscopic findings. We conclude that ultrasound is a simple, accurate, inexpensive and non invasive way of diagnosing knee disorders with a learning curve.

Keywords – Arthroscopy, Diagnostic Knee tests, High Resolution Ultra sound (HRUS), Internal derangement of Knee(IDK), X-rays of Knee.

[1]. H Gerngross, C. Sohn. Ultrasound Scanning For The Diagnosis Of Meniscal Lesions Of The Knee Joint.( Arthroscopy 1992 ) 8 :105-110.
[2]. J. Grifka , J. Richter , M Gumtau . Clinical And Sonographic Meniscus Diagnosis.(Orthopäde 1994) 23 : 102-111.
[3]. F Corbetti , G Tomasella . Meniscal Injuries Of The Knee - Arthrographic And Echographic Study.(Radiol Med 1989) 77 : 187-194.
[4]. M Fusting , HR Casser . Dynamic Examination Technique In Meniscus Sonography. (Sportverletz Sportschaden 1991) 5 : 27-36.
[5]. HR Casser , M Fusting . Current Developments In Ultra Sonography Of The Meniscus. (Orthopäde 1993) 22 : 307-316.
[6]. T Heuchemer , G Bauer , Friedrich, Bargon. Clinical Use Of Meniscus Sonography.(Bildgebung 1987–1989) 56 : 118-123.

Abstract: Posterior Reversible Encephalopathy Syndrome (PRES) is a clinico radiological entity. Symptomatology includes cognitive and behavioural disturbances, blurred vision, seizures, headache, vomiting. MRI reveals edematous changes in white and grey matter of brain. The most common etiology of PRES is Hypertensive encephalopathy, Eclampsia, Preeclampsia, Immunosuppressant drugs and cytotoxic drugs. PRES is usually reversible and the treatment is based on the management and withdrawal of the triggering factor. We report a case of PRES, occurred after consuming alcohol while on Disulfuram which is a rare etiological entity.

Keywords: Cortical Blindness, Disulfuram and alcohol induced PRES, Focal neurological signs.

[1] Bartynski WS. Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. AJNR Am J euroradiol 2008;29:1036-42.

[2] Bartynski WS. Posterior reversible encephalopathy syndrome, part 2: controversies surrounding pathophysiology of vasogenic edema. AJNR Am J Neuroradiol 2008;29: 1043-49.

[3] Hinchey J. Chaves C, Appignani B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;334:494-500. [4] Casey SO, Sampaio RC, Michel E, Truwit CL. Posterior reversible encephalopathy syndrome: utility of fluid-attenuated inversion recovery MR imaging in the detection of cortical and subcortical lesions. AJNR Am J Neuroradiol 2000;21:1199-1206.

[5] Lee VH, Wijdicks EF, Manno EM, Rabinstein AA. Clinical spectrum of reversible posterior leukoencephalopathy syndrome, Arch Neurol 2008;65:205-10.

[6] McKinney AM, Short J, Truwit CL, et al. Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. AJR Am J Roentgenol 2007;189:904-12.
[7] Bartynski WS, Boardman JF, Zeigler ZR, Shadduck RK, Lister J. Posterior reversible encephalopathy syndrome in infection, sepsis and shock. AJNR Am J Neuroradiol 2006;27:2179-90.

Abstract: The bacterium Helicobacter pylori (H. Pylori ) has a high prevalence of up to more than 50%, especially in developing countries and this bacteria play role in many human diseases, especially duodenal ulcers, gastric ulcers and stomach cancer. The 14 carbon- urea breath test (14C-UBT) help in diagnosis of infection, this study aims to assess the diagnostic value of Heliprobe (14C-Urea Breath Test) for the diagnosis of H. Pylori infection in patients presented with dyspepsia. A prospective study was conducted at the National Center for Early Detection of Cancer for the period extending from 18th December 2011 to 18th May 2012 and the study included (74) patients, exceeded the age of (20) years old and of both sexes who had or had not a final diagnosis of H. Pylori infection depending on histological examination [the gold standard test(GS)], were subjected to an interview questions covering aspects of social and clinical characteristics in addition to the conditions of the test. The total number of patients (74) patients, 26 (35.14%) were females and 48 (64.86%) were males, 22 (29.73%) of patients within the age group (20-30 years),most patients had gastritis, by histological examination results were 49 (66.22%) positive cases and 25 (33.78%) cases were negative, and by test results were 40 (54.1%) positive cases and 34 (45.9%) cases were negative. The proportion of test sensitivity, specificity, accuracy assessment, the positive predictive value and negative predictive value in patients were (81.63%), (100%), (87.84%), (100%) and (73.53%) respectively. Conclusions: The 14C-UBT help in the diagnosis of H. Pylori infection.

Key wards: Validation, 14 Carbon-Urea Breath test, Helicobacter Pylori Infection

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[4]- A Papa, G Cammarota, A Tursi, A Gasbarrini, and G Gasbarrini, Helicobacter pylori eradication and remission of low-grade gastric mucosa-associated lymphoid tissue lymphoma: a long-term follow-up study, Clinical Gastroenterology, (31), 2000, 169–171.

[5]- R Pounder, E and D Ng, The prevalence of Helicobacter pylori infection in different countries, Alimentary Pharmacology and Therapeutics, (9), 1995, 33–39.

[6]- N R Hussein, Helicobacter pylori and gastric cancer in the Middle East: a new enigma? .World Journal of Gastro enterology, (26), 2010, 3226–3234.

[7]- N Vakil, D Rhew, A Soll, and J Ofman, The cost effectiveness of diagnostic testing strategies for Helicobacter pylori, American J of Gastroenterology, (95), 2000, 1691–1698.

Abstract: Multiple sclerosis is an immune mediated demyelinating disease of the central nervous system characterized by bouts of neurologic symptoms (or relapses) and increasing disability. The aim of this study is to elucidate the influence of seasonal variation on the nature and number of relapses in patients already diagnosed with multiple sclerosis. A cross- sectional retrospective study was carried out from January to May 2011 in Multiple Sclerosis clinic of neurological department in Baghdad Teaching hospital , including 100 relapsing- remitting multiple sclerosis patients ( 26 males and 74 females ) with 278 relapses who were registered over 5 years interval (2005-2010) ,data collected by reviewing patients records and analyzed statistically . Patients younger than 40 years significantly constitute 76%.of the sample. The largest percentages (14%) of patients were born on July. The total number of relapses was 278 distributed as 218 in females and 60 in males, the proportion of relapses in both sexes (73.7%) were higher in patients younger than 40 years. Regarding the pattern of multiple sclerosis relapses; the highest percentage (29.8%) was of sensory type. The peak of multiple sclerosis relapses was evident during January and April, with higher percentage (31.2%) in females during Spring .there was no significant differences in the proportion of relapses (29.1%, 34.7%) during Spring in both age groups and there was no relation between the type of relapse and season of occurrence. Conclusion: There is some seasonal effect on multiple sclerosis relapses, they were higher in Spring, and lower in Summer.

Key Wards: multiple sclerosis, relapse, season.

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[8]- J Salzer, A Svenningsson, P Sundstrom,. Seasons of birth and multiple sclerosis in Sweden –Acta neurol Scand; 122 (9), 2010, 70-73.

[9]- F Salvi, L Bartolome. , MH Smolensky, et al. A seasonal periodicity in relapses of multiple sclerosis.BMC Neurology, (10), (2010), 105. [10]- WD -Wayne. Biostatistics: A foundation for analysis in the health sciences 7th Edition, chapter 12, 1998, 571-600

Abstract: Ashtma is a chronic inflammatory disorder of the airways dominated by Th2. Immunotherapy was beneficial for ashtma patients. Its long duration was oftenly caused patients to drop out treatment . Probiotic and Nigella sativa as immunomodulator for asthma expectantly could increase the efficacy of immunotherapy . The aims of this study was to evaluate the therapeutic efficacy of immunotherapy combined with probiotics and Nigella sativa in the number of CD4+IL-4+ cells, Total IgE level and Asthma Scoring Test. A total of 31 children with mild asthma were evaluated and then randomized to receive immunotherapy or immunotherapy plus Nigella sativa or immunotherapy plus probiotic or immunotherapy plus Nigella sativa plus probiotic openly for 14 weeks. Statistical analysis found no significant difference in the mean number of CD4+IL-4+cells pre and posttest in all three treatment group. The Total IgE level was decreased significantly in the immunotherapy+ probiotic + Nigella sativa group (p = 0,022). The ACT score were increased in the immunotherapy + Nigella sativa group (p = 0.001), in the immunotherapy + probiotic group (p = 0.004), and immunotherapy + Nigella sativa + probiotic group (p = 0.000). Correlation test found a significant association between the number of CD4+IL-4+cells, Total IgE level and ACT score in all groups. The combination immunotherapy, Nigella sativa and probiotics could decrease the Total IgE level thus improve the clinical symptom.

Keywords – Immunotherapy, House dust mite, Probiotics, Nigella sativa, CD4+IL-4+, Ig E, Asthma Control test

[1] GINA, Global Ashtma Strategy of Management and Prevention Update 2011, In: NIO H, editor.: National Heart, Lung and Blood Institute 2011.
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[6] Arshad SH, Holgate S, The role of IgE in allergen-induced inflammation and the potential for intervention with a humanized monoclonal anti-IgE antibody, Clinical & Experimental Allergy,31,2001, 1344-51.
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[9] Loyd CM, Hawrylowicz CM, Regulatory T Cells in Asthma, Immunity,9,2009.
[10] Robinson D, Allergen immunotherapy : does it work and if so for how long, Thorax,55,2000, s11-4.

Abstract: The word epulis is a clinical term used to describe a localized growth on the gingiva. Histologic examination of epulides indicates that the vast majority are the fibrous hyperplasias, peripheral ossifying fibomas, pyogenic granulomas or peripheral giant cell granulomas. The major epulides are common oral lesions with which dentists should be thoroughly familiar. The clinical and histological relevance of the two cases are discussed and analyzed for their biological behaviour.

Key Words: Epulis, Peripheral Giant Cell Granuloma, Giant Cell Epullis, Reparative Giant Cell Granuloma, Giant Cell Granuloma.

[1] Daley T.D., Wysocki G.P., Wysocki P.D. and Wysocki D.M.: The major epulides: Clinocopathological correlations. J Can Dent Assoc. 1990; 56(7):627-630.
[2] Whitaker S.R. and Bouquot J.E.: Identification of estrogen and progesterone receptors in peripheral giant cell lesions of the Jaws. J Periodontol. 1994; 65(3):280-283.
[3] Giansanti J.S. and Waldron C.A.: Peripheral Giant Cell Granuloma: Review of 720 cases. J Oral Surg. 1969; 27:787-791.
[4] Cooke B.E.D.: The fibrous epulis and the fibroepithelial polyp: Their histogenesis and natural history. Br Dent J. 1952; 93:305- 309.
[5] Brown G.N., Darlington C.G. and Kupfer S.R.: A clinico-pathologic study of alveolar border epulis with special emphasis on benign giant cell tumor. Oral Surg. 1956; 9:765-775, 888-901.
[6] Anderson B.G.: Epulis. A series of cases. Arch Surg. 1939; 38:1030-1039.
[7] Bhasker S.N., Duane E., Beasley J.D. and Perez B.: Giant cell reparative granuloma (Peripheral): Report of 50 cases. J Oral Surg. 1971; 29:110-115.
[8] Neville B.W. et al., Oral and maxillofacial pathology (1st Ed. Philadelphia :W.B. Saunders Company, 1995).
[9] Katsikeris N., Kakarontza A. and Angelopoulos A.P.: Peripheral Giant Cell Granuloma. Clinicopathologic study of 224 new cases and review of 956 reported cases. Int J Oral Maxillofac Surg. 1988; 17:94-99.

Abstract: Objective: In view of the current trend of cardiovascular diseases in sub-Saharan Africa, coupled with the majority of the population in the rural setting and the need for preventive strategy, this study aimed at determining the 10-year absolute risk for cardiovascular events in rural setting of AayeEkiti, Ekiti State, South West Nigeria. Methods: Cross sectional study was conducted in a typical rural community in Ekiti State, Southwest, Nigeria involving 183 participants aged 40 to 79 years. A well-structured questionnaire was administered to determine the sociodemographic variables and relevant risk factors such as age, gender, total cholesterol, high density lipoprotein cholesterol, smoking, and systolic blood pressure were determined. Framingham risk calculator was used to determine the 10-year absolute risk in line with National Cholesterol Education Program Adult Treatment Panel III Version. Results: The study involved 183 participants, age ranged 40 to 79years, 34.4% were males while 65.6% were females. Over half (59.1%) belong to the low risk (˂10%) category, while 31.1% belong to the intermediate risk category (10-20%) and 9.8% belong to the high risk category (˃20%). There was statistical significant difference between males and females. Conclusion: Based on the results, the high proportion of patients in the intermediate and high risk categories suggest need for necessary preventive intervention strategy to be part of health care program in the rural settings.

Key Words: Assessment,Risk Factors, Nigeria, Rural Communities,Primary, Prevention.

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Abstract: Recent studies suggest that regulatory T cells (Treg cells) and immunosuppressive cytokines such as interleukine-10 (IL-10) have a role in pathogenesis of asthma and efficacy of allergen specific immunotherapy (SIT). Since immunotherapy had limitations, several adjuvants proposed to improve its efficacy such as probiotic and Nigella sativa. The aim of this study is to evaluate the effect of combination of immunotherapy house dust mite and probiotic or Nigella sativa either on the induction of CD4+CD25+foxp3+Treg and CD4+IL-10+ or the control of asthma symptoms in mild asthmatic children. Thirty one mild asthmatic children were evaluated and then randomized to receive immunotherapy plus placebo, immunotherapy plus probiotic, immunotherapy plus Nigella sativa, or immunotherapy plus probiotic plus Nigella sativa for 14 weeks. The number of CD4+CD25+foxp3+Treg, CD4+IL-10+ and Asthma Control Test (ACT) score were measured before and after treatment. CD4+CD25+foxp3+Treg cell number has unsignificant decreased on all treatment groups. There was an unsignificant increase of CD4+IL-10+ number in immunotherapy plus placebo group whereas unsignificant decrease was found in the other three groups. All of groups showed a significant increase of ACT score except immunotherapy and placebo group. Adjuvant probiotic or Nigella sativa in immunotherapy can improve asthma symptoms in mild asthmatic children.

Keywords – Asthma control test, CD4+CD25+foxp3+Treg, CD4+IL-10+, immunotherapy, Nigella sativa, probiotic

[1] Kiotseridis H, Cilio CM, Bjermer L, Aurivillius M, Jacobsson H, Dahl Å, et al., Quality of life in children and adolescents with respiratory allergy, assessed with a generic and disease-specific instrument, Clin Respir J 2012.
[2] Supriyatno HB. Diagnosis dan Penatalaksanaan Terkini Asma pada Anak Maj Kedokt Indon. Maret ed. Jakarta: Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universita Indonesia /Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo; 2005. p. 237-43.
[3] Braman SS, The Global Burden of Asthma*, Chest, 130, 2006, 4S-12S.
[4] Hawrylowicz CM, O'Garra A, Potential role of Interleukin-10-secreting regulatory T celss in allergy and asthma, Nature Rev Immunol, 5, 2005, 271-83.

Abstract: Purpose-The purpose of pre and post experimental study was to know the effect of Proprioceptive Neuromuscular Facilitation techniques on muscle endurance, functional performance on post-partum lumbo-pelvic pain and to compare it with lumbo-pelvic stabilization exercises. Background- Pregnancy and child birth elicit psychosocial and physical changes with pain in pelvic or lower back. There is focus on importance of activation of muscles for motor control and stability of lumbo-pelvic region. Specific stabilizing exercises programs in women with post partum pelvic pain improves functional status and reduced pain. Method-A total of 28 females were taken on the basis of inclusion (7SI joint test) and exclusion criteria and divided into two groups via convenient sampling. Group A (n=14) received set of lumbo-pelvic stabilization exercises after IRR and Group B (n=13) received proprioceptive neuromuscular facilitation techniques (rthymic stabilization and combination of isotonics) after IRR for four weeks. All the outcome variables i.e. trunk flexors and extensors static and dynamic endurance, pain and quality of life were measured at 0 (pre-test), 2nd and 4th week. Results- Paired t-test indicated that Group A (Lumbo-pelvic stabilization group) demonstrated significant improvements in static and dynamic muscle endurance, pain and Quebec back pain disability scale, measurements. However Group B (proprioceptive neuromuscular facilitation group) also shows improvement on the measure of functional ability and pain from baseline. With in group analysis was done found to be significantly different. Conclusion- The results of the study suggest that both the groups show improvement but lumbo-pelvic stabilization exercises are beneficial for improving trunk muscle endurance, pain and functional ability in women with post partum lumbo-pelvic pain.

Keywords: lumbo-pelvic pain, postpartum, muscle endurance, proprioceptive neuromuscular facilitation, stabilization exercises

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[4]. Britt Stuge, Even Laerum, Gitle Kirkesola, The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy, Spine, 29(4), 2004, 351–359.
[5]. Jennifer Sabino, JonathanN.Grauer, Pregnancy and low back pain, Curr Rev Musculoskeletal Med, 1(2), 2008, 137–141.
[6]. Joanne E. Bullock, Gwendolen A. Jull, Margaret I. Bullock The relationship of low back pain to postural changes during pregnancy, The Australian Journal of Physiotherapy, 33(1), 1987,10-17.
[7]. O'Sullivan, Peter B, Evaluation of Specific Stabilizing Exercise in the Treatment of Chronic Low Back Pain With Radiologic Diagnosis of Spondylolysis or Spondylolisthesis, Spine, 22(24),1997,2959-2967.
[8]. Larry A. Wolfe and Gregory A. L. Davies, Canadian guidelines for exercise in pregnancy, Clinical Obstetrics and Gynecology, 46 (2), 2003, 488–495.
[9]. Caroline HG Bastiaenen, Rob A de Bie et al.,Long-term effectiveness and costs of a brief self-management intervention in women with pregnancy-related low back pain after delivery. BMC Pregnancy and Childbirth, 8(19), 2008.
[10]. Hala M. Hanfy et al, Evaluation of Lumbo-Pelvic Stabilizing Exercises in the Treatment of Backache after Normal Labour, Journal of American Science,7(2), 2011,270-276.

Abstract: Introduction: Foetal spinal cord has been the focus of interest by many scientists but the information regarding lumbar enlargement received very little attention, though important for clinical applications. Morphological studies were limited to vertebral canal and spinal cord during prenatal and postnatal periods . Readings of maximum transverse diameter of lumbar enlargement of foetal spinal cord will help in understanding the pattern of growth of spinal cord in Indian human foetuses, which may be utilised for medicolegal purpose. Material and Methods: Foetuses without any congenital cranio-vertebral anomalies were selected for the study and divided into five groups on the basis of gestational age. Laminectomy was performed and the spinal cords from human foetuses were taken out and maximum transverse diameter of lumbar enlargement was measured by Vernier calipers under standard conditions. Result & Conclusion: Significant increment in maximum transverse diameter of lumbar enlargement of foetal spinal cord was observed in successive adjacent groups from group II onwards. There was maximum increment in maximum transverse diameter of lumbar enlargement of spinal cord between groups IV and V human foetuses.

Key Words: spinal cord, lumbar enlargement, human foetus, transverse diameter

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