Neurotoxicity is an infrequent adverse reaction to iodinated contrast agents. Contrast induced neurotoxicity following coronary angiogram is very rare. Renal disease is a risk factor for contrast induced neurotoxicity...Neurotoxicity is an infrequent adverse reaction to iodinated contrast agents. Contrast induced neurotoxicity following coronary angiogram is very rare. Renal disease is a risk factor for contrast induced neurotoxicity. We report a case of contrast induced neurotoxicity following coronary angiogram and intervention using Iohexol(Omnipaque 350) in an end stage renal disease patient on peritoneal dialysis who had prior exposure to iodinated contrast without any adverse reaction. Hemodialysis had to be initiated for rapid removal of the contrast agent with subsequent complete resolution of neurological deficits. This case highlights the need for interventionalists to be aware of an important adverse reaction to iodinated contrast agents, especially in individuals with renal dysfunction, and that neurotoxicity is a possibility even with prior uneventful exposures. The role and timing of hemodialysis in contrast induced neurotoxicity in patients with chronic kidney disease and in those without chronic kidney disease needs further deliberation.展开更多
Primary sclerosing cholangitis(PSC) remains a rare but significant disease, which affects mainly young males in association with inflammatory bowel disease. There have been few advances in the understanding of the pat...Primary sclerosing cholangitis(PSC) remains a rare but significant disease, which affects mainly young males in association with inflammatory bowel disease. There have been few advances in the understanding of the pathogenesis of the condition and no therapeutics with proven mortality benefit aside from liver transplantation. There remain areas of controversy in the management of PSC which include the differentiation from other cholangiopathies, in particular immunoglobulin G4 related sclerosing cholangitis, the management of dominant biliary strictures, and the role of ursodeoxycholic acid. In addition, the timing of liver transplantation in PSC remains difficult to predict with standard liver severity scores. In this review, we address these controversies and highlight the latest evidence base in the management of PSC.展开更多
End-stage liver disease(ESLD) is a leading cause of morbidity and mortality amongst human immunodeficiency virus(HIV)-positive individuals. Chronic hepatitis B and hepatitis C virus(HCV) infection,drug-induced hepatot...End-stage liver disease(ESLD) is a leading cause of morbidity and mortality amongst human immunodeficiency virus(HIV)-positive individuals. Chronic hepatitis B and hepatitis C virus(HCV) infection,drug-induced hepatotoxicity related to combined antiretro-viral therapy,alcohol related liver disease and non-alcohol related fatty liver disease appear to be the leading causes. It is therefore,anticipated that more HIV-positive patients with ESLD will present as potential transplant candidates. HIV infection is no longer a contraindication to liver transplantation. Key transplantation outcomes such as rejection and infection rates as well as medium term graft and patient survival match those seen in the non-HIV infected patients in the absence of co-existing HCV infection. HIV disease does not seem to be negatively impacted by transplantation. However,HIV-HCV coinfection transplant outcomes remain suboptimal due to recurrence. In this article,we review the key challenges faced by this patient cohort in the pre- and posttransplant period.展开更多
AIM To assess the functional and clinical results of repair of chronic tears of pectoralis major using corkscrew and sliding suture technique. METHODS In this retrospective study, we reviewed the results of pectoralis...AIM To assess the functional and clinical results of repair of chronic tears of pectoralis major using corkscrew and sliding suture technique. METHODS In this retrospective study, we reviewed the results of pectoralis major repair in 11 chronic cases(> 6 wk) done between September 2011 and December 2014 at our institute. In all cases repair was done by same surgeon using corkscrew suture anchors and box suture sliding technique. At 6 mo, after surgery magnetic resonance imaging was done to see the integrity of the repair. Functional evaluation was done using Penn and ASES scores. Pre and postoperative Isokinetic strength was measured.RESULTS Average follow-up was 48.27 ± 21.0 mo. The Wilcoxon signed rank test was used to evaluate the outcome scores. The average ASES score increased from an average of 54.63 ± 13.0 preoperatively to 95.09 ± 2.60 after surgery at their last follow-up. The average Penn score also increased from 5.72 ± 0.78, 2.81 ± 1.32 and 45.81 ± 1.72 to 9.36 ± 0.80, 8.27 ± 0.90 and 59 ± 1.34 for pain, satisfaction and function respectively. Follow up magnetic resonance imaging(MRI)(at 6 mo) showed continuity and the bulk of pectoralis major muscle in all cases. Average isokinetic strength deficiency in horizontal adduction at 60° was 13.63% ± 6.93% and at 120° was 10.18% ± 4.93% and in flexion at 60° was 10.72% ± 5.08% and at 120° was 6.63% + 3.74%. Results showed that both ASES and Penn score improved significantly(2 tailed P value = 0.0036).CONCLUSION We could conclude from this series that pectoralis major repair even in chronic cases using 5.5 mm corkscrew anchors give excellent functional and cosmetic results. In chronic cases the repairable length of the tendon is not available and sliding suture technique allows for fixation of worn out tendomuscular junction to bone without letting cutting through the muscle.展开更多
The purpose of this study to evaluate the effect of mental task on gait coordination. The comparison between two techniques Crosscorrelation and Cyclo- gram has been performed. A set of gait experiments was developed ...The purpose of this study to evaluate the effect of mental task on gait coordination. The comparison between two techniques Crosscorrelation and Cyclo- gram has been performed. A set of gait experiments was developed and conducted to evaluate the effect of mental task on gait coordination. The perimeter derived from the geometric figure, cyclogram perimeter (CP), of the knee-knee cyclogram is the main descriptor considered in this study. For crosscorrelation it is the peak value of cross correlation coefficient (CCC) that has been taken for comparison. The sensitivity of both the techniques in terms of percentage has been calculated. Crosscorrelation is highly sensitive (mean=20.4 S.D.=2.3), towards the change in gait coordination with mental task, in comparison to cyclogram perimeter (mean=2.2 S.D.=1.2). The results have strength to assess the progress of rehabilitation among Parkinson patients.展开更多
A neglected shoulder dislocation is a rarer entity and only few cases are reported in the literature. An anterior dislocation of the shoulder is rarely missed as patients present with limb in abduction and external ro...A neglected shoulder dislocation is a rarer entity and only few cases are reported in the literature. An anterior dislocation of the shoulder is rarely missed as patients present with limb in abduction and external rotation, an attitude very familiar to orthopaedic surgeon. Occasionally such cases are missed when they present with fracture of proximal humerus or when they receive treatment from unqualified practitioners who commonly practise in rural areas. Owing to very few reports there is paucity of literature and no standard treatment protocol exists for neglected anterior dislocation of the shoulder. though most such chronic cases are managed by open reduction. This case report describes a six months old neglected anterior dislocation with a significant Hill Sachs lesion, which was managed by closed reduction and Latarjet procedure.展开更多
Background Tuberculosis(TB)remains a major public health problem in Nepal,high in settings marked by prevalent gender and social inequities.Various social stratifiers intersect,either privileging or oppressing individ...Background Tuberculosis(TB)remains a major public health problem in Nepal,high in settings marked by prevalent gender and social inequities.Various social stratifiers intersect,either privileging or oppressing individuals based on their characteristics and contexts,thereby increasing risks,vulnerabilities and marganilisation associated with TB.This study aimed to assess the inclusiveness of gender and other social stratifiers in key health related national policies and the Health Management Information System(HMIS)of National Tuberculosis Programme(NTP)by conducting an intersectional analysis of TB cases recorded via HMIS.Methods A desk review of key policies and the NTP’s HMIS was conducted.Retrospective intersectional analysis utilized two secondary data sources:annual NTP report(2017-2021)and records of 628 TB cases via HMIS 6.5 from two TB centres(2017/18-2018/19).Chi-square test and multi-variate analysis was used to assess the association between social stratifers and types of TB,registration category and treatment outcome.Results Gender,social inclusion and concept of intersectionality are incorporated into various health policies and strategies but lack effective implementation.NTP has initiated the collection of age,sex,ethnicity and location data since 2014/15 through the HMIS.However,only age and sex disaggregated data are routinely reported,leaving recorded social stratifiers of TB patients static without analysis and dissemination.Furthermore,findings from the intersectional analysis using TB secondary data,showed that male more than 25 years exhibited higher odds[adjusted odds ratio(a OR)=4.95,95%confidence interval(CI):1.60-19.06,P=0.01]of successful outcome compared to male TB patients less than 25 years.Similarly,sex was significantly associated with types of TB(P<0.05)whereas both age(P<0.05)and sex(P<0.05)were significantly associated with patient registration category(old/new cases).Conclusions The results highlight inadequacy in the availability of social stratifiers in the routine HMIS.This limitation hampers the NTP’s ability to conduct intersectional analyses,crucial for unveiling the roles of other social determinants of TB.Such limitation underscores the need for more disaggregated data in routine NTP to better inform policies and plans contributing to the development of a more responsive and equitable TB programme and effectively addressing disparities.展开更多
文摘Neurotoxicity is an infrequent adverse reaction to iodinated contrast agents. Contrast induced neurotoxicity following coronary angiogram is very rare. Renal disease is a risk factor for contrast induced neurotoxicity. We report a case of contrast induced neurotoxicity following coronary angiogram and intervention using Iohexol(Omnipaque 350) in an end stage renal disease patient on peritoneal dialysis who had prior exposure to iodinated contrast without any adverse reaction. Hemodialysis had to be initiated for rapid removal of the contrast agent with subsequent complete resolution of neurological deficits. This case highlights the need for interventionalists to be aware of an important adverse reaction to iodinated contrast agents, especially in individuals with renal dysfunction, and that neurotoxicity is a possibility even with prior uneventful exposures. The role and timing of hemodialysis in contrast induced neurotoxicity in patients with chronic kidney disease and in those without chronic kidney disease needs further deliberation.
文摘Primary sclerosing cholangitis(PSC) remains a rare but significant disease, which affects mainly young males in association with inflammatory bowel disease. There have been few advances in the understanding of the pathogenesis of the condition and no therapeutics with proven mortality benefit aside from liver transplantation. There remain areas of controversy in the management of PSC which include the differentiation from other cholangiopathies, in particular immunoglobulin G4 related sclerosing cholangitis, the management of dominant biliary strictures, and the role of ursodeoxycholic acid. In addition, the timing of liver transplantation in PSC remains difficult to predict with standard liver severity scores. In this review, we address these controversies and highlight the latest evidence base in the management of PSC.
文摘End-stage liver disease(ESLD) is a leading cause of morbidity and mortality amongst human immunodeficiency virus(HIV)-positive individuals. Chronic hepatitis B and hepatitis C virus(HCV) infection,drug-induced hepatotoxicity related to combined antiretro-viral therapy,alcohol related liver disease and non-alcohol related fatty liver disease appear to be the leading causes. It is therefore,anticipated that more HIV-positive patients with ESLD will present as potential transplant candidates. HIV infection is no longer a contraindication to liver transplantation. Key transplantation outcomes such as rejection and infection rates as well as medium term graft and patient survival match those seen in the non-HIV infected patients in the absence of co-existing HCV infection. HIV disease does not seem to be negatively impacted by transplantation. However,HIV-HCV coinfection transplant outcomes remain suboptimal due to recurrence. In this article,we review the key challenges faced by this patient cohort in the pre- and posttransplant period.
文摘AIM To assess the functional and clinical results of repair of chronic tears of pectoralis major using corkscrew and sliding suture technique. METHODS In this retrospective study, we reviewed the results of pectoralis major repair in 11 chronic cases(> 6 wk) done between September 2011 and December 2014 at our institute. In all cases repair was done by same surgeon using corkscrew suture anchors and box suture sliding technique. At 6 mo, after surgery magnetic resonance imaging was done to see the integrity of the repair. Functional evaluation was done using Penn and ASES scores. Pre and postoperative Isokinetic strength was measured.RESULTS Average follow-up was 48.27 ± 21.0 mo. The Wilcoxon signed rank test was used to evaluate the outcome scores. The average ASES score increased from an average of 54.63 ± 13.0 preoperatively to 95.09 ± 2.60 after surgery at their last follow-up. The average Penn score also increased from 5.72 ± 0.78, 2.81 ± 1.32 and 45.81 ± 1.72 to 9.36 ± 0.80, 8.27 ± 0.90 and 59 ± 1.34 for pain, satisfaction and function respectively. Follow up magnetic resonance imaging(MRI)(at 6 mo) showed continuity and the bulk of pectoralis major muscle in all cases. Average isokinetic strength deficiency in horizontal adduction at 60° was 13.63% ± 6.93% and at 120° was 10.18% ± 4.93% and in flexion at 60° was 10.72% ± 5.08% and at 120° was 6.63% + 3.74%. Results showed that both ASES and Penn score improved significantly(2 tailed P value = 0.0036).CONCLUSION We could conclude from this series that pectoralis major repair even in chronic cases using 5.5 mm corkscrew anchors give excellent functional and cosmetic results. In chronic cases the repairable length of the tendon is not available and sliding suture technique allows for fixation of worn out tendomuscular junction to bone without letting cutting through the muscle.
文摘The purpose of this study to evaluate the effect of mental task on gait coordination. The comparison between two techniques Crosscorrelation and Cyclo- gram has been performed. A set of gait experiments was developed and conducted to evaluate the effect of mental task on gait coordination. The perimeter derived from the geometric figure, cyclogram perimeter (CP), of the knee-knee cyclogram is the main descriptor considered in this study. For crosscorrelation it is the peak value of cross correlation coefficient (CCC) that has been taken for comparison. The sensitivity of both the techniques in terms of percentage has been calculated. Crosscorrelation is highly sensitive (mean=20.4 S.D.=2.3), towards the change in gait coordination with mental task, in comparison to cyclogram perimeter (mean=2.2 S.D.=1.2). The results have strength to assess the progress of rehabilitation among Parkinson patients.
文摘A neglected shoulder dislocation is a rarer entity and only few cases are reported in the literature. An anterior dislocation of the shoulder is rarely missed as patients present with limb in abduction and external rotation, an attitude very familiar to orthopaedic surgeon. Occasionally such cases are missed when they present with fracture of proximal humerus or when they receive treatment from unqualified practitioners who commonly practise in rural areas. Owing to very few reports there is paucity of literature and no standard treatment protocol exists for neglected anterior dislocation of the shoulder. though most such chronic cases are managed by open reduction. This case report describes a six months old neglected anterior dislocation with a significant Hill Sachs lesion, which was managed by closed reduction and Latarjet procedure.
基金funded by the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases(TDR),World Health Organization,Geneva,Switzerland(Reference 2019/980668-1)
文摘Background Tuberculosis(TB)remains a major public health problem in Nepal,high in settings marked by prevalent gender and social inequities.Various social stratifiers intersect,either privileging or oppressing individuals based on their characteristics and contexts,thereby increasing risks,vulnerabilities and marganilisation associated with TB.This study aimed to assess the inclusiveness of gender and other social stratifiers in key health related national policies and the Health Management Information System(HMIS)of National Tuberculosis Programme(NTP)by conducting an intersectional analysis of TB cases recorded via HMIS.Methods A desk review of key policies and the NTP’s HMIS was conducted.Retrospective intersectional analysis utilized two secondary data sources:annual NTP report(2017-2021)and records of 628 TB cases via HMIS 6.5 from two TB centres(2017/18-2018/19).Chi-square test and multi-variate analysis was used to assess the association between social stratifers and types of TB,registration category and treatment outcome.Results Gender,social inclusion and concept of intersectionality are incorporated into various health policies and strategies but lack effective implementation.NTP has initiated the collection of age,sex,ethnicity and location data since 2014/15 through the HMIS.However,only age and sex disaggregated data are routinely reported,leaving recorded social stratifiers of TB patients static without analysis and dissemination.Furthermore,findings from the intersectional analysis using TB secondary data,showed that male more than 25 years exhibited higher odds[adjusted odds ratio(a OR)=4.95,95%confidence interval(CI):1.60-19.06,P=0.01]of successful outcome compared to male TB patients less than 25 years.Similarly,sex was significantly associated with types of TB(P<0.05)whereas both age(P<0.05)and sex(P<0.05)were significantly associated with patient registration category(old/new cases).Conclusions The results highlight inadequacy in the availability of social stratifiers in the routine HMIS.This limitation hampers the NTP’s ability to conduct intersectional analyses,crucial for unveiling the roles of other social determinants of TB.Such limitation underscores the need for more disaggregated data in routine NTP to better inform policies and plans contributing to the development of a more responsive and equitable TB programme and effectively addressing disparities.