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Eosinophilic Gastroenteritis Presenting as Intestinal Obstruction - A Case Series.
No full textEosinophilic Gastroenteritis is a rare disease characterized by infiltration of the gastrointestinal tract by an increased number of eosinophils as compared to the normal. The anatomic location and intensity of the infiltrate decides the varied clinical symptomatology with which these patients present. The present report deals with four cases, all presenting with clinical signs of intestinal obstruction A laparotomy performed revealed a stricture in the first case, superficial ulcers and adhesions in the second case, an ileocaecal mass in the third case and volvulus formation in the fourth case. Eosinophilic gastroenteritis was confirmed on histopathology in all the four cases. All the four patients experienced relief of symptoms after resection. It is essential to diagnose the disease to differentiate it from other conditions presenting as intestinal obstruction. The cases are presented because of the rarity of occurrence and presentation. Relevant literature has been reviewed
Human Dipylidiasis: A Case Report of Dipylidium caninum Infection from Karimnagar.
No full textDipylidium caninum also refered to as the double-pored tapeworm is a cyclophyllidean cestode that commonly infects dogs and cats. Mammals act as definite hosts with intermediate hosts being dog and cat flea, the Ctenocephalides canis and Ctenocephalides catis respectively. The dog lice, Trichodectes canis and human flea (Pulex irritans) also transmit Dipylidium caninum infection. Infants and young children are at high risk of acquiring infection. Majority of the infections are due to close association with pet dog and cats. Humans are accidental hosts who acquire infection by ingestion of infected dog and cat fleas. We report a rare case of Dipylidium caninum infection in a 9 year old girl who could have acquired infection by consuming food contaminated with infected fleas
Study of the Clinical Patterns in Varicella in a Tertiary Hospital at Coastal Karnataka
No full textContext: There are very few studies regarding the clinical patterns and manifestations of a very common viral infection, Varicella, especially from south India. Aims: To study the cutaneous manifestation of Varicella with an emphasis on vaccination status. Settings and Design: Cross sectional study. Methods and Material: A total of 118 patients attending the Dermatology OPD of a private medical college in coastal Karnataka with cutaneous manifestations of varicella were enrolled. Study period was from January 2010 to December 2010. Statistical analysis used: Data was analysed using SPSS version 11.5. Various frequency distribution tables, diagrams and chi square test were used to describe and analyse the data. Results: Majority of the patients were males (62.7%) and 21-30 years was the most common age group involved. There were 74 students, out of which eight were in the preschool group aged between 3-4 years. Most of the patients visited the hospital on the second day after onset of the symptoms. 108(91.5%) patients complained about the presence of various prodromal symptoms. Scalp was the most common (39.8%) site of onset of the rash. Itching was experienced by 76(64.4%) patients. Peak number of cases (35.6%) was seen in the month of January. The cutaneous rash was most commonly (57.7%) distributed over face, scalp, trunk, upper and lower limbs, with predominantly central distribution. Soft palate was the most common site (87%) involved in the oral cavity. Conclusions: A wide variety of combination symptoms with classical cutaneous polymorphic vesicular rash and oral lesions was seen
Strategies in skill acquisition: reconciling continuous models of the learning curve with abrupt strategy shifts.
No full textHow does task completion time change with practice and what processes underlie this change? Despite over 100 years of scientific research (e.g., Bryan & Harter, 1899) no wholly satisfactory answer has yet emerged. After analysing many skill acquisition datasets Newell and Rosenbloom (1981) influentially declared that the relationship between practice and task completion time was best represented by a power function labelling the relationship the Power Law of Practice. Use of the term ‘law’ might suggest that the case was closed, yet several recent findings have challenged the Power Law’s ‘legal’ status. First, Heathcote, Brown, and Mewhort (2000) concluded that the Power Law of Practice was an artefact of aggregation. Across a large number of skill acquisition datasets they showed that when analysed at the individual-level the exponential function tended to provide superior fit. Second, several researchers have suggested that strategy shifts may even cause discontinuities in the learning curve (e.g., Delaney, Reder, Staszewski, & Ritter, 1998; Haider & Frensch, 2002; Rickard, 1997). In summary, findings suggest that the power function is an analytical artefact and that learning may in some instances involve discontinuities.\ud
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In response to these challenges, this thesis had three aims. The first aim was to develop and test mathematical models of the relationship between practice, strategy use and performance. The second aim was to assess the role of individual differences, including prior experience, ability, and personality in predicting strategy use and performance. The third aim was to model the differential effects of instructed versus self-initiated strategy shift on strategy use and performance. Collectively, the aims were designed to provide a multifaceted explanation of the relationship between practice, strategy use, and performance.\ud
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To achieve these aims three studies were conducted. In each study participants completed a set of trials on a text editing task. On each trial strategy sophistication and task completion time were measured. Final sample sizes in the three studies were n1 = 63, n2 = 154, and n3 = 154. Each study also measured a selection of individual difference variables including prior experience, demographics, personality, and ability. Text editing was chosen as the criterion task because strategy use is important to task performance and strategy use could readily be measured. The text editing task was developed to enable trial-level measurement of strategy use. Strategy sophistication was operationalised as the proportion of key presses used that were classified as sophisticated (e.g., using control and right cursor keys to move between words) as opposed to simple (e.g., using just the right cursor to move between characters). In Studies 1 and 2 all participants received the same instructions. In Study 3 participants were randomly assigned to one of three conditions with varying instructions. In a No Training condition practice preceded without interruption, in a Training condition additional instructions were presented halfway through practice, and in a Control condition a filler task was presented halfway through practice. Aims 1 and 2 were assessed by Study 1 and 2 and the No Training condition of Study 3. Aim 3 was assessed by comparing the conditions in Study 3.\ud
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With regard to Aim 1 results from the three studies told a consistent story. Results reiterated the importance of analysing data at the individual-level. While at the group-level, a three parameter power function provided superior fit, at the individual-level a three parameter exponential function was significantly better in two out of three studies. Similarly, at the group-level, strategy sophistication was a continuously increasing, monotonically decelerating function of practice, well modelled by a three parameter Michaelis–Menten function. In contrast, at the individual-level, the functional form of the relationship varied dramatically between individuals with a variety of often discontinuous functions providing good fit.\ud
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Although abrupt strategy shifts did occur, meaningful discontinuities in the relationship between practice and task completion time were rare. Findings supported a model that explained how abrupt strategy shifts can co-occur with continuous learning curves. These findings were that: (a) strategy shifts were more likely to occur early in practice when other learning was occurring; (b) trial-to-trial variance in task completion time was often large relative to the benefits of the strategy shift; and (c)strategy shifts often took several trials to be fully realised. These and other factors combined to generally smooth out the discontinuous effects of strategy shift on performance.\ud
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In relation to the second aim, concerning individual differences, ability and prior experience consistently emerged as moderate to strong predictors of task performance, whereas self-reported Big 5 personality was unrelated to task performance. Similar but generally weaker relationships were found between individual differences and strategy sophistication. A model that proposed that the effect of ability and prior experience on task performance was mediated by strategy sophistication was not supported. Findings were broadly consistent with cognitive correlates and skill transfer models of individual differences.\ud
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In relation to the third aim, looking at differences between instructed strategy shift and self-initiated strategy shift, hypotheses were partially supported. In summary, relative to self-initiated strategy shifts, instructed strategy shifts were more abrupt. Performance also tended to decline sharply immediately following the instructed strategy shift. After additional practice, performance was similar to groups that had not received instructed strategy shift. The study highlighted how the dynamics of instructed strategy shift differ from self-initiated strategy shift with regards to discontinuities.\ud
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Taken together the results tell an interconnected story regarding the relationship between practice, strategy use, and performance. This thesis contributes to skill acquisition research through a unique combination of features including trial-level measurement of strategy use, individual-level modelling, and the use of nonlinear and discontinuous functions. It is hoped that future research will build on this approach using other samples, tasks, and contexts
Decompression of inferior alveolar nerve: case report comment
No full textParesthesia as a result of mechanical trauma is one of the most frequent sensory disturbances of the inferior alveolar nerve. This case report describes surgical treatment for paresthesia caused by a compressive phenomenon within the mandibular canal. The cause of the compression, a broken instrument left in the patient's mouth during previous endodontic therapy, was identified during routine radiography and computed tomography. Once the foreign object was removed by surgery, the paresthesia resolved quickly. This case highlights the potential for an iatrogenic mechanical cause of paresthesia. Comment : The article by Marques and Gomes (J Can Dent Assoc 2011;77:b34) caught my attention. For your information, there is almost an almost similar case reported recently, but with dysesthesia.1 It is fortunate that the patient in the current case has less severe symptoms (occasional numbness of her left lip and a small part of her chin, and a tingling sensation in the vestibular gingival). What I can deduce from the radiographs shown is that the file was actually lodged onto the wall of the periapical defect and the mandibular canal, and because of this the inferior alveolar nerve (IAN) was spared direct injury. Ikeda et al.2 had shown that there is room between the IAN and the canal. However, as reported by the Marques and Gomes, her symptoms were more aggravated in the morning and during stressful situations. This may be a result of fluid accumulation in the morning, or during any sympathetic (stressful) event, that may result in vasodilatation, and hence compression within the narrow mandibular canal that usually average 3.4 + 0.5 mm in diameter. 2,3 I hope this opinion is of help. Thank you
The challenge of complexity for cognitive systems
No full textComplex cognition addresses research on (a) high-level cognitive processes – mainly problem solving, reasoning, and decision making – and their interaction with more basic processes such as perception, learning, motivation and emotion and (b) cognitive processes which take place in a complex, typically dynamic, environment. Our focus is on AI systems and cognitive models dealing with complexity and on psychological findings which can inspire or challenge cognitive systems research. In this overview we first motivate why we have to go beyond models for rather simple cognitive processes and reductionist experiments. Afterwards, we give a characterization of complexity from our perspective. We introduce the triad of cognitive science methods – analytical, empirical, and engineering methods – which in our opinion have all to be utilized to tackle complex cognition. Afterwards we highlight three aspects of complex cognition – complex problem solving, dynamic decision making, and learning of concepts, skills and strategies. We conclude with some reflections about and challenges for future research
Prevalence of Depression Among Medical Students of a Private Medical College in India
No full textBackground: Medical education can contribute to the development of depression in medical students which may have possible negative academic and professional consequences. The aims of this study were to explore the prevalence of depressive symptoms and their relationships to socio-demographic variables among a cross section of medical students of a private medical college in India. Methods: A cross-sectional anonymous questionnaire-based survey was conducted including all students from first to fourth year of a medical college in India. Beck depression inventory was used to assess the level of depression with a score of 12 or higher considered depressive. Additional questions regarding demographic variables were also included in the survey. Data analysis was done on Epi info version 6. Results: A total of 336 students participated giving a response rate of 88%. A total of 49.1% students reported depressive symptoms. It was significantly higher in 1st year (59.3%) and 2nd year (65.6%), as compared to 3rd (34.4%) and 4th year (37.2%) students [p<0. 05]. Substance abuse(p<0.0001), first and second year of study, female sex and language of instruction other than English at 10+2 level were associated factors for the development of depressive symptoms [p<0.05]. A significant negative association was also found between regular exercise and depression (p<0.05). Conclusion: Depression may be a significant hidden problem in Indian medical students and mechanisms to identify and help students with mental health problems should be seriously considered
Characteristics of Fatal Cases of Pandemic Influenza A (H1N1) from September 2009 to January 2010 in Saurashtra Region, India
No full textBackground: India reported first case of 2009 pandemic influenza A (H1N1) virus infection in May, 2009 and Saurashtra region in August, 2009. We describe the characteristics of fatal cases of 2009 influenza A (H1N1) infection reported in Saurashtra region. Methods: From September, 2009 to January, 2010, we observed 71 fatal cases that were infected with 2009 influenza A (H1N1) virus and admitted in different hospitals in Rajkot city. Real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) testing was used to confirm infection; the clinico-epidemiological features were observed and documented. Results: Median age of the deceased (71) was 29 years, and 57.7% were females. Median time observed was 5 days from onset of illness to diagnosis of influenza A (H1N1), and 57.7% were referred from general practitioner (OR=0.42, CI=0.24-0.74). Median hospital stay reported was 3 days. All admitted patients received oseltamivir, but only 16.9% received it within 2 days of onset of illness. The most common symptoms were cough (97.2%), fever (93%), sore throat and shortness of breath. Co-morbid conditions were present in almost half of the patients who ultimately died, the most common of which was pregnancy (OR=0.15, CI=0.04-0.52). Radiological pneumonia was reported in 98% patients. Conclusion: Residing in urban area, delayed referral from general practitioner, presence of co-existing condition, especially pregnancy was responsible for mortality among influenza A (H1N1) infected positive
Should Magnesium Sulphate Prophylaxis be Used in all Cases of Severe Preeclampsia?
No full textA case control study, undertaken in the department of Obstetrics and Gynecology in a tertiary referral centre, was designed to administer standard dose of magnesium sulphate to 50 randomly selected severely preeclamptic women in labor (Group 1). 48 women who formed the control group did not receive the drug (Group 2). The admission – delivery interval, rate of Cesarean section showed no statistically significant difference. Four patients developed convulsions in Group 1 in contrast to twelve patients in Group 2. Efficacy of magnesium sulphate at preventing eclampsia was calculated as 68%. Mild respiratory depression occurred in two cases and oliguria in eight cases in Group 1. Both the conditions improved on suspending further doses of magnesium sulphate. No patient had post partum haemorrhage in Group 1 although 4% patients had it in Group 2. Neonatal outcome was comparable in both the groups. Hence magnesium sulphate may be regarded as a fairly safe and effective prophylactic agent for eclampsia when used in severe preeclampsia in labo
Cortisol Secreting Adrenal Adenoma in a 5 Year Old Child
No full textAdrenal adenoma is a rare endocrinal tumor in children. It can present with features of Cushing's syndrome. We present a case report of five years old female child who came with morbid obesity and hypertension. The patient manifested polyphagia, weight gain, and changes in sleep patterns. During physical examination we found a full-moon face, bulkiness in the cervico-dorsal (buffalo-hump) region, high blood pressure