Complete recovery of chronic Osmotic Demyelination Syndrome with plasma exchange
Published on: 8th March, 2018
OCLC Number/Unique Identifier: 7877940509
A 50-years old female presented with dysarthria, inability to swallow and quadriparesis for three weeks. She had rapid correction of her serum sodium (Na) from 99meq/l to 138meq/l within 24 hours 1 week prior to development of these symptoms. She was diagnosed as a case of Osmotic demyelination syndrome (ODS) formerly known as central pontine myelinolysis (CPM) which was confirmed by MRI. She underwent Plasma Exchange (PE) on the 20th day since her symptoms started and underwent 7 cycles of PE with complete neurological recovery. Pt was discharged with ability to ambulate independently and complete recovery of speech and swallowing. Hence, we report that PE is beneficial in chronic ODS.
Overview on current approach on recurrent miscarriage and threatened miscarriage
Published on: 30th November, 2020
OCLC Number/Unique Identifier: 8875583329
Miscarriage is a frequent outcome of pregnancy, with major emotional implications to the couple experiencing such an event. Threatened miscarriage is the commonest complication of early pregnancy and affects about 20% of pregnancies. It presents with vaginal bleeding with or without abdominal cramps. On the other hand recurrent miscarriages are post implantation failures in natural conception. Increasing age of women, smoking, obesity or polycystic ovary syndrome (PCOS) and a previous history of miscarriage are risk factors for threatened miscarriage. The pathophysiology has been associated with changes in levels of cytokines or maternal immune dysfunction. Clinical history and examination, maternal serum biochemistry and ultrasound findings are important to determine the treatment options and provide valuable information for the prognosis. Many surgical and non-surgical interventions are used in the management of threatened and recurrent miscarriages. In this review, we present available evidence-based guidance on the incidence, pathophysiology, investigation and clinical management of recurrent miscarriage and threatened miscarriage, focusing mainly on the first trimester of pregnancy and primary healthcare settings. The review is structured to be clinically relevant. We have critically appraised the evidence to produce a concise answer for clinical practice.
Detection of IDH mutations in cerebrospinal fluid: A discussion of liquid biopsy in neuropathology
Published on: 17th September, 2020
OCLC Number/Unique Identifier: 8873201615
Isocitrate dehydrogenase (IDH) mutations are a common event in secondary glioblastoma multiforme and lower-grade adult infiltrative astrocytomas and independently confer a better prognosis [1,2]. These are highly conserved mutations during glioma progression and thus also a useful diagnostic marker amenable to modern molecular sequencing methods. These mutations can even be detected in sites distant from the primary tumour. We use an illustrative case of a patient with radiologically suspected recurrent astrocytoma and negative histology, but positive IDH-mutated tumour DNA detected within CSF. Our results demonstrated the usefulness of liquid biopsy for recurrent glioma within the context of equivocal or negative histopathological results, whilst also showing the ability to detect a de-novo IDH-2 mutation not present in the previous resection. Building on this ‘proof-of-concept’ result, we also take the opportunity to briefly review the current literature describing the various liquid biopsy substrates available to diagnose infiltrative gliomas, namely the study of circulating tumour DNA, circulating tumour cells, and extracellular vesicles. We outline the current challenges and prospects of liquid biopsies in these tumours and suggest that more studies are required to overcome these challenges and harness the potential benefits of liquid biopsies in guiding our management of gliomas
4-year recurrence risk factors after tension-free vaginal tape-obturator as a treatment of stress urinary incontinence
Published on: 4th November, 2020
OCLC Number/Unique Identifier: 8875587752
Objectives: Tension-free vaginal tapes are the gold standard of the surgical treatment of stress urinary incontinence (SUI); however, long-term recurrence of SUI after this surgery has been a matter of problem. Here, we attempted to determine the incidence of its recurrence and to identify the risk factors of 4-year-recurrence of SUI after this surgery.
Methods: Of all patients undergoing this surgery (n = 341, 2015-2019), 71 patients were met the study inclusion criteria. Of 71, SUI recurred in 8 patients, with the recurrence rate being 11.3%. The following three were identified to be independent risk factors: older age, history of delivery of macrosomic baby (>4 kg), and the presence of mixed urinary incontinence. The frequency of recurrence in cases with mixed incontinence amounted for 19.5%. Recurrence was 22 and 50% for women with macrosomic delivery once and more than twice, respectively.
Conclusion: Advanced age, macrosomic delivery and mixed urinary incontinence have shown to be independent risk factors of recurrence of SUI after tension-free vaginal tape-obturator at 4 years.
Key message: Stress urinary incontinence can recur so investigate possible risk factors is a priority. Our paper relates recurrence with: advanced age, fetal macrosomia and mixed incontinence.
Posterior Reversible Leukoencephalopathy Syndrome in a patient after second dose of Rituximab for treatment of resistant Thrombotic Thrombocytopenic Purpura
Published on: 16th February, 2018
OCLC Number/Unique Identifier: 7347066275
Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome with clinical features of altered sensorium, headaches, visual problems and seizures. It has been associated with uncontrolled hypertension (HTN), thrombotic thrombocytopenic purpura (TTP) and immunosuppressive drugs. Rituximab has also been implicated as a cause of PRES that usually occurs after the first dose. We report a case of PRES that occurred after the second dose of Rituximab. A twenty three years old female known case of resistant TTP treated with multiple courses of steroids and plasmapharesis was admitted with renal failure, severe volume overload ad lower respiratory tract infection. She was treated with hemodialysis, intravenous antibiotics, steroids and plasma exchange (PEX).
Experiment of a novel four-spherical intrauterine contraceptive device with nickel-titanium
Published on: 20th October, 2020
OCLC Number/Unique Identifier: 8691260293
The aim of this study was to develop a novel four-spherical intrauterine contraceptive device (4-SIUD) with nickel-titanium (Ni-Ti) for human, and to evaluate the contraceptive effect. The 4-SIUD composed of 4 mesh spheres and 5 support arms. The shape of 4-SIUD was like a “T”. The height (H), upper width (D) and thickness of the 4-SIUD for macaques were 0.8 cm, 0.5 cm and 0.3 cm, and for human were 4.5 cm, 4.0 cm and 0.8 cm, respectively. The 4-SIUD was inserted into 5 macaques and pregnancy was not observed at 12 months. Three women used the 4-SIUD for 12 months, uterine perforations, expulsion, pain, and pelvic inflammatory did not occur. The results suggested that the 4-SIUD is appropriate for rhesus macaques and human use, and has a good contraceptive effect.
Association between bh4/bh2 ratio and Albuminuria in Hypertensive Type -2 Diabetic patients
Published on: 29th December, 2017
OCLC Number/Unique Identifier: 7338866036
Endothelial dysfunction and inflammation play a key role in the pathophysiology of diabetic nephropathy; Tetrahydrobiopterin (BH4) is an essential cofactor for nitric oxide synthase, when BH4 is reduced to dihydrobiopterin (BH2), endothelial dysfunction is induced.
Purpose: The aim of this study is to evaluate the relationship between the levels of biopterins with albuminuria in type-2 diabetic hypertensive patients.
Methods: We studied 30 hypertensive type-2 diabetic patients in whom biopterins levels were measured by reverse phase high performance liquid chromatography with fluorescence detection. Additionally, 24 h urinary albumin excretion was also measured (nephelometry). The levels of biopterins and albuminuria were correlated with the Pearson correlation coefficient.
Results: We did not find a significantly correlation between biopterins levels and albuminuria, However, we found a significantly inverse correlation (R= -0.498, p<0.005) between the BH4/BH2 ratio and albuminuria.
Conclusion: Our results suggest that the BH4/BH2 ratio instead of biopterins levels may be a marker of nephropathy in hypertensive type-2 diabetic patients.
Molecular analysis of immunoglobulins related to Salmonella typhi in pediatric patients
Published on: 24th April, 2020
OCLC Number/Unique Identifier: 8591037429
Typhoid fever is a systemic infection caused by Salmonella enterica serotype typhi. It is of major concern in tropical regions of the world. Highest episodes of typhoid fever occur in Asia i.e.93%. Early diagnosis of the disease is mandatory to lower the mortality rate associated with it as well as to prevent the emergence of antimicrobial drug resistance by Salmonella typhi. Research work was conducted in Immunology Department of the Children’s Hospital, Lahore for the period of one year including a total of 60 patients suspected of having typhoid fever. Serum samples of these patients were tested for typhidot IgG and IgM antibodies as well as for the antibodies against TO and TH antigens using Widal test. Of the total 60 patients, 10 (16.7%) were positive for both typhidot IgG and IgM, 16 (26.7%) were positive for typhidot IgM, 3 (5%) were Positive for typhidot IgG and 31 (51.66%) were negative for both typhidot IgG and IgM. Reading the results of Widal test, 8 (13.33%) were positive for Widal TO and TH antigens, 3 (5%) were positive for Widal TO antigen, 19 (31.7%) were positive for Widal TH antigen and 30 (50%) were negative for Widal TO and TH antigens. IgM is positive at the early stage of acute typhoid fever, IgM along with IgG positive means the middle stage of acute illness. The detection of only IgG cannot discriminate between acute and convalescent phases as it can stay in the serum for at least 2 years or more. The typhidot test is much helpful for the rapid diagnosis of typhoid fever as compared to Widal test which is still being used in some set ups in poor countries, although has become mostly obsolete. By testing the rise of IgM and IgG antibodies against Salmonella typhi, we can detect the infection at early and late stages, respectively
Characterization of plastic degrading bacteria isolated from landfill sites
Published on: 28th May, 2020
OCLC Number/Unique Identifier: 8605989023
The plastic pollution is threatening the environment because it has very slow degradation rate and high usage in regular activities. The present study aims at the isolation of novel microorganisms that would assist faster degradation process of polyethylene. The waste samples were collected from different landfills and dumpsites. Out of forty samples, eight samples were found to degrade polythene strips in liquid medium. Further screening of these samples showed that two strains of microbes had high potential for polythene degradation. Biochemical tests and ribotyping were performed for characterization of isolated bacteria. Resultantly, two novel bacterial strains were identified named; Bacillus wudalianchiensis_UMT (2A) and Pseudomonas aeruginosa_UMT (6). Analysis of these microbes further revealed that Bacillus wudalianchiensis_UMT and Pseudomonas aeruginosa_UMT have capability to degrade 6.6% and 4.8% polyethylene respectively. So, the results disclosed that these bacteria have great potential to degrade polythene in less time as compare to natural degradation process and can contribute to reduce pollution from our environment.
Short term effect of Intravenous Intermittent Iron Infusion versus Bolus Iron Infusion on Iron parameters in Hemodialysis patients
Published on: 21st December, 2017
OCLC Number/Unique Identifier: 7317597713
Intravenous iron is used in combination with erythropoi esis-stimulating agents to treat the anemia of hemodialysis patients, however, there is variety in the dose and the frequency. So we compare bolus intravenous iron administration protocol vs an intermittent intravenous iron infusion protocol for 3 months in a single blinded design that was conducted on 30 patients randomized into 2 matching groups. Iron parameter, hemoglobin level, and CRP were monitored before and at the end of study. Patients with end stage renal disease on regular hemodialysis with iron deficiency anemia can be treated with intravenous iron administration either by the protocol of divided doses of IV iron through the sessions of hemodialysis or by giving the total dose of iron needed as a single large dose on only one session of hemodialysis, obtaining the same outcome in correction of iron parameters in treatment of iron deficiency anemia.
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