International Journal of Research in Medical Sciences
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Fundamentals of ballistics for the treatment of firearms injuries in reconstructive surgery
Get PDFFirearm injuries constitute a significant global public health challenge, whit more than one billion firearms in circulation and an estimated 600 daily fatalities. This review explores fundamental ballistics concepts and their relevance to injury mechanisms. It highlights the critical role of kinetic energy and projectile behaviour, such as velocity, trajectory, and design, in determining injury severity. High velocity firearms, expanding bullets, and shotgun shells create complex injury patterns, emphasizing the emphasizing the importance of distinguishing between permanent and temporary cavities during clinical assessment. The knowledge of ballistic principles is indispensable for plastic and reconstructive surgeons managing firearm injuries. Understanding projectile and tissue interactions informs precise surgical planning for soft tissue and bone reconstruction, enhancing patient outcomes. This expertise is essential in addressing the rising number of firearm related cases in region whit prevalent armed violence such as Mexico. Continuous integration and updating of ballistic knowledge in surgical practices are vital to improving care and minimizing long term sequelae in affected patients
ACE-ARBS-induced cholestasis: a case report
Get PDFAngiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are commonly utilized antihypertensive medications with a proven safety record. Nevertheless, they have been associated with few instances of drug-induced liver injury (DILI), namely cholestatic liver injury. This report details a case of recurrent cholestatic hepatotoxicity linked to both an ACE inhibitor and an angiotensin receptor blocker, emphasizing the diagnostic difficulties and potential for cross-reactivity. A 50-year-old female with hypertension developed progressive jaundice and pruritus two weeks after initiating an ACE inhibitor. Laboratory tests revealed a cholestatic pattern of liver injury, and extensive workup ruled out alternative etiologies. A liver biopsy confirmed drug-induced cholestasis. Following ACEI discontinuation, her liver function improved; however, two months later, she experienced recurrent cholestatic liver injury after switching to an ARB. The ARB was discontinued, and medical management with ursodeoxycholic acid, prednisolone, and N-acetylcysteine was initiated. The patient showed gradual biochemical improvement over follow-up, though prolonged cholestasis was noted. The recurrence of liver injury with the ARB suggests potential cross-reactivity between ACEIs and ARBs in susceptible individuals. ACEI- and ARB-induced cholestasis is a rare but significant adverse effect requiring early recognition and drug discontinuation. This case underscores the importance of considering drug-induced hepatotoxicity in patients with unexplained liver dysfunction and highlights the risk of recurrent injury with ARB substitution
In vitro evaluation of raft-forming and non-raft forming antacids marketed in India
Get PDFBackground: Raft properties of alginate‐antacids may vary based on their formulation. This study compared the physicochemical characteristics such as raft properties of Digeraft Plus® versus four other raft-forming (brands A to D) and acid neutralizing properties of raft-forming antacids versus two non-raft forming (brands E, F) antacids marketed in India.
Methods: The study assessed acid neutralizing capacity (ANC), and acid neutralizing potential (ANP) of the raft and non-raft forming antacids and the effect of raft structure on neutralization profile, raft strength, and raft resilience of the raft-forming antacids. Sodium alginate content of the raft-forming antacids was measured by a validated high-performance liquid chromatography (HPLC) assay.
Results: The raft-forming formulations were able to neutralize acid better than non-raft forming formulations. Total duration of acid neutralization of Digeraft Plus® was found to be 72±5.33 mins while for the other raft as well as non-raft forming antacid products, it was in the range of 40 to 60 mins. Additionally, it also had raft strength of around 20.5 gm which was significantly higher than other raft-forming brands (p<0.05) indicating enhanced raft integrity and retention. This performance correlates with its sodium alginate content, which was greater than 90%.
Conclusions: Results indicate that minor differences in formulation can affect the raft properties, and consequently, its in-vivo clinical efficacy. The strength and resilience of the rafts varied between the different alginate-based antacids available in the Indian market. Compared to other antacids, Digeraft Plus® had greater ANP, raft strength, and raft resilience
Clinical and functional outcome of minimally invasive transforaminal lumbar interbody fusion in single segment lumbar spinal disease: a prospective observational study
Get PDFBackground: Low back pain is the most common cause of work-related disability, which can be commonly caused by lumbar disc herniation, lumbar spinal stenosis, lumbar instability, and lumbar spondylolisthesis. Generally, treated conservatively, requiring surgical intervention when the effect of non-surgical management is poor or when symptoms of severe nerve damage occur. In the past decade, mainstream spinal surgery has been open surgery. Many studies have reported that minimally invasive TLIF provides equal or better results compared to open surgery. However there is very limited research on their clinical and functional outcome which is assessed in this study.
Methods: This was a prospective observational study conducted in a tertiary care hospital for one year. Patients who underwent MIS TLIF were assessed for clinical and functional outcome with ODI and VAS score pre operative and post operative at one year. Blood loss and surgical duration was also calculated. Patients aged 20-55 with lower back pain and /or neurogenic deficit that originated from single level lumbar degenerative disease were included. Those with new or old spinal fractures, previous spinal surgery and patients with medical condition requiring intensive medical therapy were excluded.
Results: The mean pre-operative VAS score was 7.64±0.95, which significantly decreased to 2.28±0.89 post-operatively, with a p-value of 0.000, indicating a statistically significant reduction in pain levels. Similarly, mean pre-operative ODI was 68.72±6.63, which decreased to 19.3.0±2.82 post-operatively, with a p value of 0.000, demonstrating significant improvement.
Conclusions: Our results suggest that MIS TLIF procedure has good clinical and functional outcome (p value <0.05) in terms of ODI and VAS Score and thus can be considered an ideal advancement in surgical procedure
Physiotherapy interventions for stroke-related dysphagia - a systematic review
Get PDFDysphagia, or difficulty in swallowing, affects over half of stroke survivors, leading to severe complications such as aspiration pneumonia, malnutrition, and dehydration. Physiotherapy interventions, including swallowing exercises, neuromuscular electrical stimulation (NMES), respiratory muscle training, and compensatory strategies, show potential in improving swallowing function. This systematic review consolidates the evidence on the effectiveness of physiotherapy interventions in stroke-related dysphagia. A systematic review was conducted using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Articles were retrieved from databases such as PubMed and Google Scholar. The review analyzed various physiotherapy interventions and their impact on swallowing function and aspiration risk. Results indicate that interventions such as chin tuck against resistance (CTAR), NMES, and respiratory muscle training significantly improve swallowing safety and function. A combination of multiple strategies yielded better results than single interventions. This study highlights the importance of individualized physiotherapy management in stroke-related dysphagia rehabilitation
Correlation between transvaginal sonographic evaluation of adenomyosis and histopathological outcomes
Get PDFBackground: Transvaginal sonography is a popular method to diagnose adenomyosis, leiomyoma and other pathology of uterus which ultimately lead to hysterectomy operative procedure. This prospective study was conducted in the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU) to evaluate the accuracy of various transvaginal ultrasonographic findings (TVS) in the diagnosis of adenomyosis with correlation of histopathological results.
Methods: One hundred and forty patients scheduled for hysterectomy also selected for preoperative transvaginal sonography. All sonographic findings were compared with the histopathological results.
Results: The prevalence of adenomyosis was 37.1%. The sensitivity and specificity of these results were 80.8% and 61.4%. The positive (PPV) and negative (NPV) predictive values were 55.3% and 84.4%. Diagnostic accuracy by transvaginal sonography for adenomyosis was 68.6%. The highest accuracy for the diagnosis of adenomyosis was globular appearing uterus, subendometrial echogenic linear striations and myometrial cysts. In the diagnosis of adenomyosis among transvaginal ultrasound findings, the subendometrial linear striations had the highest diagnostic accuracy. Heterogeneous myometrium was the most common in patients with adenomyosis but with poor specificity. The most specific sonographic features were (95.5%) in the subendometrial linear striations which also had the highest PPV (80.0%) for the diagnosis of adenomyosis. All the results have been supported by statistical tests.
Conclusions: Transvaginal ultrasound technique proved to be the very good diagnostic tools for the diagnosis of adenomyosis
Investigation of single nucleotide polymorphisms of human vitamin D receptor gene and their subsequent effects on the receptor structure and function by in silico methods
Get PDFBackground: Vitamin D receptor (VDR) polymorphism play vital role in genetic regulation of bone mass. It has been identified that the occurrence of osteoporosis mainly caused by mutations in functional regions of the VDR gene which can be highly disturb the metabolism of minerals especially the calcium ions. Our goal in this study is to use in silico methodologies and publicly accessible web databases to evaluate the impact of missense SNPs in the human VDR gene.
Methods: We used SIFT, VEP, PROVEAN, SNPs & GO, and PANTHER to predict the functional effects of mutations. I-Mutant 2.0 and Project HOPE were used to estimate the impacts on the protein's stability and three-dimensional structure. GeneMANIA has been used to evaluate how VDR gene would interact with 20 other genes.
Results: We estimate the effects of an amino acid substitution on protein structure and function depending on sequence homology, physical properties of amino acids and comparative physical properties respectively and also predicts the possible effect of an amino acid substitution on protein activity.
Conclusions: Overall, this is a thorough study that gives a quick overview of all the information on the clinically important missense SNPs of VDR gene
A case report on congenital methemoglobulinemia-neonatal cyanosis
Get PDFMethemoglobin (MetHb) is a form of hemoglobin where iron is in an oxidized ferric state, impairing its oxygen-binding capacity. This condition can be hereditary or acquired, leading to methemoglobinemia when MetHb levels exceed 3%. Hereditary methemoglobinemia, although rare, presents with hypoxia and cyanosis. This case report discusses a 1-month 7-day-old female diagnosed with congenital methemoglobinemia caused by NADH-cytochrome b5 reductase deficiency, characterized by persistent cyanosis unresponsive to oxygen therapy. The patient presented with fever, loose stools, vomiting, and respiratory distress. Initial examination revealed significant findings including pallor, hyperpigmentation of the skin, tachycardia, tachypnea, and respiratory failure. Diagnosis involved ABG with co-oximetry, revealing high MetHb levels and severe metabolic acidosis. Management included methylene blue administration, packed red blood cells (PRBC) transfusion, and supportive care. Despite initial treatment challenges, the patient showed clinical improvement with normalization of methemoglobin levels. This report emphasizes the need for accurate diagnosis and careful management of congenital methemoglobinemia to prevent complications
A clinical case of a patient with congenital heart defect and a pacemaker dysfunction
Get PDFEbstein anomaly (EA) is a congenital heart defect characterized by malformation of the tricuspid valve, leading to various cardiovascular complications, including arrhythmias and heart failure. This case report presents the clinical journey of a 33-year-old female patient with a complex medical history, including congenital heart disease (EA) and multiple interventions related to her cardiac condition, including a mechanical tricuspid valve prosthesis. Following a recent dual-chamber pacemaker implantation, the patient experienced acute episodes of sharp, electric shock-like pain in the epigastric region, and X-ray imaging revealed dislocation of the atrial electrode. Re-implantation of the atrial electrode was performed; however, the postoperative period was marked by fluctuations in the patient's condition. A multidisciplinary team involving cardiologists, clinical pharmacologists, and cardiothoracic surgeons was assembled to manage her care. The patient’s recovery trajectory showed positive dynamics, with stabilization of her symptoms and resolution of pleural effusions over time
Takayasu’s arteritis: a diagnostic dilemma
Get PDFTakayasu`s arteritis is an uncommon form of chronic vasculitis that primarily affects medium and large blood vessels, including the aorta and its major branches. The disease is mainly seen in young women. This is marked by mononuclear cell infiltration and granulomatous inflammation within the vascular media. These pathological changes result in thickening of the arterial wall, which can lead to stenosis, occlusion, or the formation of aneurysms. It can lead to severe complications such as stroke, ischaemic heart disease, pulmonary hypertension, secondary hypertension and aneurysm formation. Here we present a case of Takayasu`s arteritis in a 10-year-old girl who presented with low grade fever, headache and systemic hypertension with thickened walls of left subclavian artery and left renal artery in computed tomography angiogram. Early diagnosis and prompt treatment are crucial for managing Takayasu`s arteritis. When the disease is in a dormant phase, the prognosis tends to be more favourable