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Seronegative Rheumatoid Arthritis: A Case Control Study
No full textBackground: Seronegative Rheumatoid Arthritis (RA) is a disorder associated with considerable diagnostic, prognostic and therapeutic uncertainty for many clinicians.Objectives: The aim of this study is to elucidate clinical features at diagnosis, manifestations and treatment of patients with RA with negative serologies, as compared to a control group of patients presenting with similar polyarthralgias but diagnosed with alternative (non-RA) musculoskeletal disorders.Methods: The study was a retrospective chart review of electronic medical records from January 2003 to December 2012. Patients were identified using ICD-9 code Rheumatoid Arthritis 714.0 and at least two rheumatology clinic visits during the specified time. Charts were reviewed individually by two investigators. The inclusion criteria were a diagnosis of RA confirmed by a rheumatologist and normal values for both rheumatoid factor (RF) and anti-cyclic citrullinated protein antibodies (ACPA, third generation assay). Charts were also reviewed for eventual final diagnosis, either seronegative RA or alternate diagnosis (control group). Data were collected on demographics (sex, race, smoking status), family history of RA, and laboratory values (presence of anemia, inflammatory markers) at the time of diagnosis. The presence of erosions and synovitis identified by imaging studies was assessed. In addition, the presence of extra-articular manifestations of RA including nodules, pleural or parenchymal lung disease, eye involvement and osteoporosis was recorded. The therapies (disease modifying anti-rheumatic drug (DMARD), biologic) used to treat the seronegative RA were also reviewed. The family & smoking history and laboratory values of the seronegative RA patients were compared to the control group and analysis was done using Fisher’s exact test.Results: Charts from 107 patients were reviewed. Forty-four patients were eventually classified as having an alternate diagnosis and were considered the control group. Sixty-three patients were considered to have an established clinical diagnosis of seronegative RA. Among all patients at the time of diagnosis, 25% were smokers, 13% had a family history of RA, 54% were anemic, and 76% had abnormal ESR or CRP. The RA patients had statistically higher proportion with anemia compared to controls at presentation, and statistically lower proportion with ESR elevation compared to controls (p=0.033 and p=0.013, respectively). Seven of the 59 (11%) patients who had hand/wrist films during their care had erosions on radiography, and 6 of 13 (46%) patients who had an MRI of an extremity had findings of synovitis. Extra-articular manifestations were infrequent in this group. Forty-eight of the 62 were initiated on a DMARD, most commonly hydroxychloroquine (16% patients) or methotrexate (29% patients) or a combination of methotrexate and hydroxychloroquine therapy (35%). Of the 63 patients, 17 (27%) patients required a biologic therapy during treatment course.Conclusions: This study supports the hypothesis that clinical history and physical examination can be important determinants in helping to diagnose seronegative RA and distinguish it from other polyarthopathies. In addition to characteristic symptoms, factors which might contribute to diagnosis of RA in a patient without seropositivity include presence of anemia, and results of imaging studies
Percutaneous Coronary Intervention in Nepal
No full textIntroduction: Percutaneous coronary intervention (PCI) is an important aspect of management of ischemic heart disease. The use of PCI has expanded with importance on minimizing post-procedural vascular and bleeding complications while maintaining procedural success. The radial artery has emerged as an alternative to the femoral artery for the access sitefor the procedure.Objectives: The main objective of the study was to assess the trend of PCI, procedural outcome and complications.Methods: This is a retrospective study which included four thousand two hundred and eighty eight patients who had underwent percutaneous coronary intervention during the study period of ten years from 2002 to 2012. The data on demographic profile, angiographic characteristics, outcome and complications of the procedure were analyzed.Results: The mean age of the patients was50 ± 10.5 years ranging from 21 to 91 years. The79.5% (3409) were male and 20.5% (879) were female. The 75.3 % (3228) of the PCI were elective procedure. The 94.38% (4047) of the patient had single vessel PCI and 241(5.62%) had multivessels PCI. The PCI to LAD was the most common in 2153 (47.43%) followed by RCA 1401(30.87%) and then LCX 957 (21.08%). Overall success rate of the procedure was 95.03%. The mortality was observed in 1.07% (46) of the patients. The use of radial artery access for the PCI has a rising trend over years. The 43.5% of the procedure were performed from the radial access in 2012.Conclusion: Percutaneous coronary intervention in Nepal is increasing every year with accepted success rate and complication. With experience more complex cases are being done. Radial PCI has increasing trend
Test Retest Reliability of Ocular Vestibular Evoked Myogenic Potential
No full textRecently oVEMP testing is used to evaluate the function of utricle, with recording from contralateral ocular muscle. Aim of the present study was to see test retest reliability of oVEMP response. A total of 40 normal healthy participants were included for the present study and they underwent oVEMP testing for three recording sessions i.e. test, intra test and inter test sessions. Excellent and near excellent reliability was obtained for both latencies, and n1-p1 peak to peak amplitude. Thus it can be concluded from the current research study that VEMP testing procedures are reliable in normal hearing individuals across, within and between test recordings
Terminal Ileum Land Marking in Small-Bowel Capsule Endoscopy
No full textTerminal Ileum Land Marking in Small-Bowel Capsule Endoscop
Prevalence of Preauricular Sinus in Lautech Teaching Hospital, Osogbo, Southwest, Nigeria.
No full textIntroduction: This study aims to determine the prevalence of pre-auricular sinus and its associated symptoms and its management modality in a tertiary health facility in Oshogbo, south western NigeriaMethods: A prospective cross sectional descriptive study which was carried out between July 2012 and March 2013.Results: A total of 588 patients participated in the study consisting of 347 (59%) male with m: f ratio 1.4:1. The age of the participants ranged from 6 months to 80years with a mean age of 37.14 years. Sixty six participants had pre-auricular sinus with a prevalence of 11.2%. Majority (70%) of the pre-auricular sinus were found in males and the right ear was mostly affected 30 (49.2%). Twenty three (34.8%) had symptoms and only 3% had surgical intervention while others were managed conservatively with administration of appropriate antibiotics and analgesic. None of them had hearing loss or renal complication.Conclusion: There is a high prevalence of preauricular sinus in our environment with fewer patients manifesting symptoms. A very low proportion of patients with symptoms usually present for definitive management (surgery) in our environment; this may be related to strong cultural belief that militates against its prompt treatment. Association with renal impairment or hearing loss appear to be a rear occurrence in our environmen
Finasteride: Facts and Myths
No full textMedia reports, Internet sites and misinformation by alternative medicine practitioners recently contributed to a negative image associated with finasteride, leading to apprehension and concern among patients taking the medication. Frequently, even dermatologists seem to be hesitant to prescribe the drug for long periods, mistakenly fearing the occurrence of long-term side effects. Finasteride, either alone or in combination with topical minoxidil, is an excellent option for men with androgenetic alopecia, reducing hair loss, and/or restoring hair growth in 9 of 10 patients. The drug can be taken at any time of the day, with or without food. There are no reports of significant drug interactions or allergies. Because it is metabolized in the liver, the drug should be used with caution in patients with liver diseases, but there is no need to indicate liver function tests frequently yet
The Research Progress of PDGF-C/PDGFR-a Signaling Pathway in Renal Fibrosis and its Traditional Chinese Medicine Intervention
No full textTraditional Chinese Medicine (TCM) is a valuable heritage of human experience [1]. Salvia (dan shen) is one of the most widely used herbs in TCM for treating kidney diseases. Whereas, Salvianolic acid A, B and C are Salvia’s important component. The component compatibility of them for renal fibrosis is a doable and innovative proposition. The literature describing intervention effect of compatibility of Salvia miltiorrhiza water-soluble active components on PDGF-C/PDGFR-α signaling pathway in renal fibrosis. The summary of renal fibrosis, the etiology and pathogenesis of PDGF-C/PDGFR-α signaling pathway and the development in the research of TCM intervention were all examined. PDGF-C and PDGFR-α contribute to the formation of the renal cortical interstitium. Almost all experimental and human renal diseases are characterized by altered expression of the PDGF-C/PDGFR-α signaling pathway. Accordingly, component compatibility of TCM is an effective treatment for renal fibrosis, which is a most innovative application. It can improve renal function, renal tubular function and kidney pathology both in animal experiments and cell culture. Accordingly, it probably has a certain protective effect to the kidney
Speech Motor Control in Children with Downs Syndrome: Evidences from Formant Centralization Ratio
No full textIntroduction: Studies have highlighted the sensitivity of Formant centralization ratio (FCR) in the identification of vowel centralization. Since children with Downs Syndrome (DS) are found to exhibit imprecise articulation, the present study aimed at evaluating whether children with DS exhibit vowel centralization using FCR.Method: The study included 30 children with Downs syndrome and 30 healthy age and gender matched controls in the age range of 6-8 years. Materials consisted of 9 words with three vowels (/i/, /u/, and /a/) in the initial, medial, and the final word positions respectively. First and second formant frequency values were extracted using PRAAT software. The vowel-formant data (e.g., frequency of F1, F2 etc.) were separately averaged for each child and then the FCR was constructed from these averages using the formula (F2u+F2a+F1i+F1u) / (F2i+F1a). Independent t-test was employed to find out the significance of difference between the means of the two groups.Results: The results of Independent t-test revealed significant difference between the mean FCR of both the groups at t= 8.535, p < 0.00 indicating higher FCR values in children with Downs syndrome in comparison to typically developing peers.Conclusion: The results of the present study indicated that FCR obtained from both the groups vary significantly, thereby indicating that the vowel production in children with Downs syndrome may be subjected to vowel centralization. The present findings suggest the potential abilities of FCR metric in identifying vowel errors without characterizing the nature of vowel abnormalities and hence this metric should be used in the clinical population with caution
Psychological Work Environment and Professional Satisfaction Among Indian Audiologists
No full textObjective: The study examined self-reported work environment and professional satisfaction among Indian audiologists.Method: A cross-sectional online survey was conducted using the demand-control-support questionnaire (DCSQ), a short version of the effort-reward-imbalance (ERI) questionnaire and open-ended questions to explore professional issues. Seventy-one Indian audiologists participated in the survey.Results: No association was found between demographic factors (i.e., gender, education, work type, and work settings) and the DCSQ and ERI sub-scales. Using the demand control model, 14% of audiologists reported working in a high-stress psychological work environment. Using the ERI ratio to estimate the imbalance between efforts and reward, it was observed that 72% of the participants experienced unfavourable working situations where the reward did not correspond to the effort made. Audiologists identified various professional issues including ‘lack of awareness of the profession among public’ and ‘unethical practice by other professionals and unqualified people is a concern’, and also made some suggestions on how to overcome them.Conclusions: The results suggest that a high percentage of audiologists perceive to be practising in high effort-low reward working conditions in comparison with audiologists in other countries such as Sweden. Further work is required to understand, and possibly overcome various professional concerns raised by audiologists
Spectral Fluorescence Method for Protein Extraction Process Control
No full textIn this work we propose novel technology for the on-line monitoring of animal by-product (ABP) rendering using a spectral fluorescence signature (SFS) analyzer integrated into the recirculation line of the extracted liquid. First, we investigated various methods that could be used for on-line monitoring and control of protein extraction processes and determined that measuring the tryptophan fluorescence intensity is an effective measure of the protein content in the liquid phase. We measured the change in fluorescence intensity while performing liquid extraction on various raw materials. A series of samples was taken during each extraction and the dry matter content was determined using a standard technique. We found a good correlation between the tryptophan fluorescence intensity and the dry matter content (R2>0.90). This spectral monitoring method could also be used to carry out express-analyses to determine the chemical composition of extracts from other processes, such as the heat-treatment of organic materials, and moreover can be used to control these treatment processes