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   2012| May  | Volume 4 | Issue 5  
    Online since May 8, 2012

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Diagnosis and Management of Gallbladder Polyps
Ĺke Andrén-Sandberg
May 2012, 4(5):203-211
DOI:10.4103/1947-2714.95897  PMID:22655278
Gallbladder cancer is a rather uncommon disease, when it gives symptoms it has usually reached an incurable stage. Therefore, every attempt must be made to find the asymptomatic stages and look for premalignant gallbladder polyps. Even if gallbladder cancer is a rare disease, gallbladder polyps are common, only a few polyps develop to cancer. This makes gallbladder polyps another problem: which are the polyps that must be surgically removed, which shall be followed-up, or for how long? The author used the keyword "gallbladder polyps" in PubMed and reviewed the scientific literatures published from January 2000 to December 2011. The present review article has summarized almost all respects of gallbladder polyp, including the risk factors, clinical diagnosis and management, and comments made from the author, in which clinical treatments are recommended. It is author's purpose that the 11-year-knowledge about gallbladder polyps summarized from all worlds' literatures is enough to know how clinicians will handle the next patient with gallbladder polyp.
  11,134 1,440 77
HIV-Tuberculosis: A Study of Chest X-Ray Patterns in Relation to CD4 Count
Mahesha Padyana, Raghavendra V Bhat, M Dinesha, Alam Nawaz
May 2012, 4(5):221-225
DOI:10.4103/1947-2714.95904  PMID:22655281
Background : Fight against human immunodeficiency virus (HIV) is incomplete without addressing problems associated with difficult diagnosis of tuberculosis in HIV-Tuberculosis coinfected patients. Chest X-ray is a primary tool to evaluate tuberculosis in HIV. Aim: To assess and compare various radiological patterns of pulmonary tuberculosis in HIV patients and compare these patterns in relation to CD4 counts. Materials and Methods : Prospective cohort study was conducted in a tertiary hospital in South India from September 2009 to July 2011 with 200 HIV positive patients. WHO guidelines were used for diagnosis of HIV and tuberculosis. Results : 27% of the patients had sputum positive pulmonary tuberculosis, with higher incidence (33%) among CD4 less than 200 as compared to CD4 more than 200 (14%). Infiltration (39%) followed by consolidation (30%), cavity (11%), and lymphadenopathy (9%) seen with CD4 less than 200. Infiltration (37.5%) followed by cavity (25%) and miliary (25%) with CD4 above 200. Bilateral (68.5%) and mid and lower zones or all zone involvement more commonly seen. Conclusion : In patients with CD4 lower than 200 noncavitory infiltration and consolidation predominated. Involvement of lungs was atypical; diffuse or mid and lower zone involvement than classical upper lobe involvement. A high index of suspicion is necessary for the accurate and timely diagnosis of tuberculosis in HIV positive patients.
  6,715 812 25
Early Prediction of Acute Kidney Injury by Clinical Features of Snakebite Patients at the Time of Hospital Admission
Jayanta Paul, Somnath Dasgupta
May 2012, 4(5):216-220
DOI:10.4103/1947-2714.95903  PMID:22655280
Background: Snakebite is a major health problem in India. Venomous snakebite, which is an important medical hazard in several tropical countries including India, affects thousands of people per year and some of them develop acute kidney injury (AKI). Aims: This study was performed to find out 1) early clinical predictors for acute kidney injury in snakebite patients at the time of hospital admission and 2) incidence of acute kidney injury in snakebite patients. Materials and Methods: 171 consecutively admitted non-diabetic, non-hypertensive snakebite patients were examined. Multivariate linear regression analysis with 95 percent confidence interval (CI) was done for statistical analysis. Analyses were performed by software Statistical Package for the Social Sciences (SPSS) (17 th version for Windows). Results: Incidence of acute kidney injury was 43.27%. Development of acute kidney injury was independently associated with 20 min whole blood clotting test (20 min WBCT) (P value = 0.029; CI 95%), dark or brown color urine (P value = 0.000; CI 95%), and time interval between snakebite and anti-snake venom administration (P value = 0.000; CI 95%). Age (P value = 0.011; CI 95%) and presence of neurological signs (P value = 0.000; CI 95%) were negatively correlated with development of acute kidney injury. Conclusion: Incidence of acute kidney injury is slightly higher in our study than previous studies. Early prediction of acute kidney injury development in snakebite patients can be done by presence of black or brown urine, 20 min WBCT > 20 min, and increased time interval between snakebite and administration of anti-snake venom at the time of hospital admission. Young age group of snakebite patients develops acute kidney injury more commonly.
  3,829 523 10
A Primary Synovial Sarcoma of Lung
PP Roy, A Das, A Sarkar, AK Dwari, S Datta
May 2012, 4(5):241-243
DOI:10.4103/1947-2714.95911  PMID:22655286
Primary pulmonary synovial sarcoma is an extremely rare tumor. The diagnosis is established only after sarcoma like primary lung malignancies and metastatic sarcoma have been excluded. It has four subtypes: monophasic fibrous, monophasic epithelial, biphasic, and poorly differentiated subtypes, We report a case of a 55-year-old man, who complained of left-sided chest pain and shortness of breath, had a large heterogeneous mass, occupying most of left hemithorax, associated with ipsilateral pleural effusion, seen on contrast enhanced computed tomogram of thorax. Computed tomography guided tru-cut biopsy revealed spindle cell sarcoma. On immunohistochemistry, tumor cells expressed epithelial membrane antigen, CD99, bcl-2 and Calponin and were immunonegative for cytokeratin. So, final diagnosis was primary pulmonary synovial sarcoma, Primary pulmonary synovial sarcoma is a rarely reported case of malignant neoplasm of lung. Histopathology, immunohistochemistry, and cytogenetics, if possible, are essential for confirmation of its diagnosis.
  3,689 592 6
Transobturator Tape in Treatment of Stress Urinary Incontinence: It is Time for a New Gold Standard
Navneet Magon, VSM Sanjiv Chopra
May 2012, 4(5):226-230
DOI:10.4103/1947-2714.95905  PMID:22655282
Background: Stress urinary incontinence (SUI) can significantly impair the quality of life. A variety of treatments, both medical and surgical, have been used to manage it. The transobturator sling, which is a subfascial sling, is relatively a new surgical technique with minimal access. Aim: The objective of this study was to evaluate the effectiveness of transobturator tape (TOT) in the treatment of female SUI and to analyze functional results. Materials and Methods: A total of 59 patients were applied TOT by outside-in technique and various outcome parameters recorded. These patients were followed up 6 months after surgery. Results: Success rate of TOT was 93.2% (95% CI: 86.4-99.5). A total of 51 patients (86.4%) were completely satisfied, whereas 4 (6.8%) were partially satisfied and 4 were unsatisfied with surgical outcome. The procedure-related complications were few and could be managed in the same sitting. Conclusion: The transobturator approach is an effective treatment of SUI with low morbidity, and it has all the potential to be the new Gold Standard in the treatment of female SUI.
  3,776 431 11
Familial Xanthelasma with Dyslipidemia: Just Another Family Trait?
Shridhar Dwivedi, Amitesh Aggarwal, Safal Singh, Vishal Sharma
May 2012, 4(5):238-240
DOI:10.4103/1947-2714.95910  PMID:22655285
Some external features serve as a warning sign for accelerated atherosclerosis. Their early recognition may help in early detection and primary prevention/preemptive treatment of coronary artery disease (CAD). A 35-year-old nonsmoker, nonalcoholic, nonhypertensive, nondiabetic male presented with chest pain and was diagnosed to have acute ST elevation inferior wall myocardial infarction. His father had died of CAD at 40 years of age. The patient had bilateral extensive xanthelasma and gynoid obesity. His mother and younger brother also had evidence of bilateral xanthelasma; both turned out to be dyslipidemic - the younger brother qualifying for therapeutic intervention for dyslipidemia at 26 years of age. This case highlights the importance of familial xanthelasma as a cutaneous marker for underlying dyslipidemia and accelerated atherosclerosis in the young.
  3,774 325 5
Duplex Detection of TP53 Arg72Pro and 16 bp Del/Ins Polymorphisms by a Simple Optimized PCR-RFLP Method
B Lajin, A Alachkar, Sakur A Alhaj
May 2012, 4(5):212-215
DOI:10.4103/1947-2714.95900  PMID:22655279
Background: The tumor suppressor gene (TP53) encodes p53, the central protein in the apoptotic pathway which has been shown to be of crucial importance in the development of cancers in addition to a variety of neurodegenerative disorders. Two most commonly studied polymorphisms that were shown to affect the biochemical functions of p53 protein are the exon 4 Arg72pro and Intron 3 16 bp Del/Ins polymorphisms. Aims: The aim of the present work is to develop a new optimized method for the simultaneous detection of the two important polymorphisms in the TP53 gene in a single reaction. Materials and Methods: The proposed method is based on amplification of a single PCR amplicon and the use of a unique restriction enzyme with restriction sites that facilitate simultaneous detection. Results: The proposed method offers fast, economical, and simple simultaneous detection. Validation by methods commonly used in the literature showed perferct concordance in genotyping results. Conclusion: The proposed method can serve as an invaluable tool for the investigation of TP53 Arg72Pro-16 bp Del/Ins haplotype, and the combined effects of the two polymorphisms offering extreme ease and simplicity over the currently used methods which are based on two separate detections.
  3,569 390 -
Multiple Unerupted Teeth with Amelogenesis Imperfecta in Siblings
Shruthi Hegde
May 2012, 4(5):235-237
DOI:10.4103/1947-2714.95908  PMID:22655284
Amelogenesis imperfecta encompasses a group of inherited abnormalities that are generally considered to primarily affect the formation and/or calcification of enamel. This case report describes the unusual presentation of amelogenesis imperfecta in siblings as multiple unerupted teeth, multiple pulpal calcifications, and multiple dilacerations of roots along with the defect in the enamel. The intent of our report is to highlight a rare co-occurrence of amelogenesis imperfecta with multiple morphologic alterations in siblings.
  3,509 383 4
Assessment of Prevalence of Non-tuberculous Mycobacteria in Archival Acid-fast Bacilli Positive Smear Slides by TaqMan Real-time PCR Assay
Taghi Naserpour Farivar, Pouran Johari, Abbas Ali Moien, Mohammad Hashemi Shahri, Mohammad Naderi, Hamid Oskouie
May 2012, 4(5):231-234
DOI:10.4103/1947-2714.95907  PMID:22655283
Background: The emergence of non-tuberculous mycobacteria as clinically relevant pathogens has necessitated us for the study of these organisms in the context of their environment. Differentiation of Mycobacterium tuberculosis complex and non-tuberculous mycobacteria is important especially when we have a positive smear slide test result. Aim: In this study, we planned to survey the prevalence of tuberculosis and non-tuberculous mycobacteria among archival acid-fast bacilli positive smear slides. Materials and Methods: A number of 200 acid-fast bacilli positive smear slides were collected from different parts of Sistan and Baluchestan Province, the biggest province of Iran with the highest incidence of tuberculosis. The presence of mycobacterial IS6110 was evaluated in slides' scraped material by TaqMan real-time polymerase chain reaction assay. Results: The real-time polymerase chain reaction tests of archival acid-fast bacilli positive smear slides showed that 171 slides from 200 examined slides had M. tuberculosis DNA and in the remaining 29 examined slides, M. tuberculosis DNA was not found. Conclusion: Our findings showed that there was no M. tuberculosis DNA in 14.5% of archival AFB positive smear slides, and this finding necessitates us to reviewing our diagnostic and anti- tuberculous protocols.
  3,056 380 2
Methodological Issues in Treatment Adherence Studies
Ravi Prakash Upadhyay, Prashant Jarhyan, Oluwakemi Odukoya
May 2012, 4(5):244-244
DOI:10.4103/1947-2714.95912  PMID:22655287
  2,249 261 -