A clinicopathological study of histomorphological differentiation and staging of lymph node metastasis in periampullary carcinoma

Background: The periampullary region is an anatomically and histologically complex area that is prone towards malignant transformation. Malignancies in this region have increased in incidence in the last few decades. Classifying these malignancies has become crucial for prognosis and treatment. With the pancreato-biliary type being more aggressive as compared to the intestinal type. Lymph node metastasis and lymph node ratio also aid in prognostication. Methods: This prospective descriptive study was conducted over one year from August 2022 on 30 patients diagnosed with periampullary tumors who underwent pancreatoduodenectomy and biopsy. Histopathological classification and prognostic factors were analyzed based on Kimura et al classification. Results: The study included 18 males and 12 females with a mean age of 53.47 years. The origin of the tumor was the head of the pancreas in 66.66% (n=20) of the patients. Adenocarcinoma was the most common histological type. The pancreato-biliary type of adenocarcinoma was more aggressive than the intestinal type when primary tumor size and staging were compared. Conclusions: Periampullary carcinomas are difficult to classify. Kimura et al classification is an important classification system that helps in the treatment and prognostication of the patient. The pancreato-biliary type of adenocarcinoma is more aggressive as compared to the intestinal type. Lymph node metastasis and lymph node ratio are also important prognostic factors

Assessment of functional outcome of distal femur intra-articular fractures treated with locking compression plate

Background: Intra-articular distal femoral fracture makes up to 6% of all femur fractures. Because they damage the cartilage surface of the bone, intra-articular fractures can be more difficult to treat. The locking compression plates have nowadays proven to be gold standard in treating both simple as well as complex intra-articular distal femur fractures. This study is to evaluate the complications, functional and anatomical outcome of distal femur fractures, treated by open reduction and internal fixation using distal femoral locking compression plate.Methods: This is a retrospective study of 30 patients with intra articular distal femur fractures operated with distal femur locking compression plate during the period of 2015 to 2018 in a tertiary care hospital with age range from 17 to 71 years and follow up till 2 years. Fractures were classified according to AO classification and functional outcome assessed by using Neer criteria.Results: 10 cases had excellent score (33%), 16 cases (52%) had satisfactory score, 3 cases (11%) had unsatisfactory score and only one case had poor score. 85.1% of patients were in between satisfactory to excellent results. Complications observed were excessive bleeding, difficulty in reduction, superficial infections, knee stiffness, malalignment and limb length discrepancy.Conclusions: The distal femur locking compression plate is a good implant to be used for distal femur intra-articular fractures. Early surgery, anatomical reduction and early mobilisation are the prerequisites for good functional outcome. Comminution and bone defect on the medial side needs pillar reconstruction by fibular bone graft

Vitamin C supplementation as adjuvant analgesic therapy in post-operative pain management in patients undergoing surgical decompression in a case of prolapsed intervertebral disc

Background: The management of postoperative pain has been a major challenge for the operating surgeons. Vitamin C has shown analgesic effects in specific clinical conditions, reducing patient suffering and improving the quality of life. The objective of this study was to evaluate the efficacy of vitamin C as an adjuvant in postoperative pain management and its effect on analgesia requirements in patients undergoing spinal decompression surgery.Methods: The present study was a prospective study of 50 patients aged 30-60 years with low back pain due to prolapsed intervertebral disc requiring surgical decompression, conducted in a tertiary care institute from 2018 to 2020. All patients underwent open discectomy. 25 patients each were randomized into two groups, those that were given vitamin c supplementation (group A) and those that weren't (group B). The patients were then followed up 1st, 2nd, 4th, and 6th week and the pain was graded at each follow-up according to the NRS scale. The total amount of diclofenac sodium consumed in the 6 weeks was calculated.Results: The mean NRS (A vs B) at 2 (2.68 vs 3.56) and 4 (0.88 vs 1.48) weeks follow-up showed a statistically significant difference between the two groups, but the difference was not significant at 6 (0.16 vs 0.36) weeks follow up. The difference in the consumption of analgesic (3.56 vs 5.46) at 6 weeks was statistically significant.Conclusions: In this clinical outcome-based study, we suggest that for postoperative pain management, vitamin C acts as an efficacious adjuvant with a dose-sparing effect on the consumption of analgesics

Study of the immediate short term clinical and radiological outcome of intertrochanteric neck of femur fractures treated with primary bipolar hemiarthroplasty in geriatric population in a tertiary care centre

Background: Intertrochanteric fracture in elderly patient is a frequent problem and is becoming more common as the proportion of elderly people in the population increases. Unstable intertrochanteric fracture in the elderly patient is associated with a high rate of mortality as much as 20 percent during the first postoperative year. The treatment of such unstable intertrochanteric fracture is still controversial. So as to allow for earlier postoperative weight-bearing, primary hemiarthroplasty was proposed by some authors. The purpose of this study is to evaluate the functional and clinical outcomes of cemented bipolar arthroplasty as a primary treatment for unstable intertrochanteric fracture in the elderly patient.Methods: It was an observational retrospective plus prospective study design over a period of 18 months in a tertiary care setting with a sample size of 41. Patients fulfilling the inclusion criteria were assessed clinically using Harris hip score and radiologically were operated for bipolar hemiarthroplasty. They were assessed intraoperatively, immediate postoperatively and after 4 weeks for functional outcome using Harris hip score and assessed radiologically. Patients were also be evaluated for intraoperative and postoperative complications if any. The outcome was analysed statistically to comment on functional outcome of bipolar hemiarthroplasty.Results: In our study majority of the patients 70% (29) had excellent and good outcomes at the end of 1 month. Out of the rest 22% more had fair outcome at the end of month. Thus 93% patients had favorable outcomes at the end of 1 month while 7% (3 cases) had poor outcome when measured using Harris hip score.Conclusions: Primary cemented bipolar hemiarthroplasty is a viable option that leads to good functional outcomes and allows early mobilization and weight bearing

Pattern self-medication use of analgesics in Pune, Maharashtra, India

Background: Objective of current study was to find out self-medication pattern and to study awareness of ADRs to analgesics self-medication.Methods: II MBBS students collected the information of names of analgesics self-medication, dose, frequency of administration, health related problem for use of self-medication, source of information for the use of self-medication and information about ADRs. Students also educated the population about ADRs to analgesics with the help of ADR checklist.Results: Paracetamol was most commonly taken as self-medication and 39% persons reported ADRs with paracetamol.  Ibuprofen, diclofenac, paracetamol and aspirin were taken less than WHO DDD for joint pain. 79% study population was ignorant about ADRs to analgesics. Headache (37%) was common health related problem for self-medication of analgesics.   Conclusion: Information about problems with repeated use of analgesics like liver damage, analgesic nephropathy, gastric ulceration/bleeding should be provided by pharmacists either orally or with the help of leaflets or display board. Headache is common health related problem for the use of analgesics as self-medication. Pharmacists should take help of assistance tool to diagnosis headache like screener for migraine and guidelines for chronic headache for timely visit of self-medicating person to physician.

Isoniazid hair concentrations in children with tuberculosis: a proof of concept study

Assessing treatment adherence and quantifying tuberculosis drug exposure among children is challenging. We undertook a “proof of concept” study to assess the drug concentrations of isoniazid in hair as a therapeutic drug monitoring tool. Children <12 years of age initiated on thrice-weekly treatment including isoniazid (10 mg/kg) for newly diagnosed tuberculosis were enrolled. Isoniazid concentrations in hair were measured using liquid chromatography-tandem mass spectrometry at 1, 2, 4 and 6 months after tuberculosis treatment initiation. We found that isoniazid hair concentrations in all children on thrice weekly isoniazid were detectable and displayed variability across a dynamic range

Management of granulomatous lobular mastitis: an international multidisciplinary consensus (2021 edition)

Granulomatous lobular mastitis (GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patients with inflammatory disorders of the breast. This consensus is summarized to establish evidence-based recommendations for the management of GLM. Literature was reviewed using PubMed from January 1, 1971 to July 31, 2020. Sixty-six international experienced multidisciplinary experts from 11 countries or regions were invited to review the evidence. Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. Experts discussed and concluded 30 recommendations on historical definitions, etiology and predisposing factors, diagnosis criteria, treatment, clinical stages, relapse and recurrence of GLM. GLM was recommended as a widely accepted definition. In addition, this consensus introduced a new clinical stages and management algorithm for GLM to provide individual treatment strategies. In conclusion, diagnosis of GLM depends on a combination of history, clinical manifestations, imaging examinations, laboratory examinations and pathology. The approach to treatment of GLM should be applied according to the different clinical stage of GLM. This evidence-based consensus would be valuable to assist front-line surgeons and medical specialists in the optimal management of GLM.Improving the Ability of Diagnosis and Treatment of Difficult Disease

Xanthogranulomatous pyelonephritis: Unusual clinical presentation: A case report with literature review

Xanthogranulomatous pyelonephritis (XGP) is rare and aggressive form of chronic infectious pyelonephritis. No single clinical or radiological feature is diagnostic of XGP. A 75-year-old man with prostatic enlargement presented with difficulty and burning micturition fever, abdominal and flank pain. X-ray, ultrasonography and computed tomography scan diagnosis was right kidney pyonephrosis. Intravenous urography revealed non-excretory right kidney. Right nephrectomy was done. Histological diagnosis of XGP was made. In all patients of prostatic enlargement, renal function must be assessed for the extent of damage. Surgery is the treatment choice in most cases. Pre- and post-operative antibiotics are key factors for successful management and better prognosis