Multidetector CT arthrography in shoulder instability and its comparison with MR arthrography and arthroscopy

Background: Purpose of this study was to compare diagnostic effectiveness of MDCT arthrography (MDCTA) in shoulder instability and pain in throwing and its comparison to MR arthrography (MRA) and arthroscopy taking arthroscopy as gold standard.Methods: 20 patients with history of recurrent shoulder dislocation in activity were included in this study. After detailed clinical examination, each patient underwent MDCT-MR arthrography in one sitting followed by diagnostic arthroscopy within 6 weeks. Results were compared with the help of statistician.Results: At arthroscopy, 10 Bankart’s lesions, 7 Hill Sachs lesion, 6 SLAP lesion, 1 ALPSA, 1 capsular laxity, 1 partial subscapularis tear and 1 supraspinatus fraying were visualized in 20 shoulders. For Bankart’s lesion MDCT has sensitivity 80%, specificity 100%, positive predictive value (PPV) 100% and negative predictive value (NPV) 83.3%. MRA has sensitivity of 90%, specificity 100%, PPV 100% and NPV 90.9%. For SLAP lesions sensitivity, specificity, PPV and NPV for MDCTA and MRA are 88.3%, 100%, 100%, 93.3%. For Hill-Sachs lesion; sensitivity, specificity, PPV and NPV for MDCTA are all 100% and for MRA they are 85.7%, 100%, 100%, 92.8% respectively. For ALPSA; sensitivity is 100%, specificity is 95%, PPV is 50% and NPV is 100% both for MDCTA and MRA. К value for MRA is 0.60 and for CTA is 0.55 suggesting moderate agreement.Conclusions: Considering availability, cost, time consumption, superior detection of bony lesions and comparable detection of soft tissue lesions; MDCTA can be used as single investigation of choice in shoulder instability pain

Gynecomastia our surgical experience using liposuction and minimal invasive surgical excision and its psychological benefits to young patients

Background: Gynecomastia is a benign enlargement of the male breast usually bilateral sometimes unilateral resulting from proliferation of glandular component of the breast. It is defined clinically by presence of rubbery or firm mass extending from nipple. The glandular tissue grows under influence of hormonal stimulation and is tender. Gynecomastia frequently presents social. Psychological, difficulties as low esteem and shame to sufferer. During adolescence many young males have gynecomastia and they are eager to do surgery of gynecomastia. Aims and objectives of the study was to correct deformity restoring normal contour to the chest, maintaining viability of nipple and areola. Also avoiding excess scarring and preventing saucer type deformity. To relieve emotional discomfort, psychological distress, and intolerable pain, to relieve shame in going to society, social gathering even doing marriage. To study effect of adding liposuction to surgical excision.Methods: This is two-year study of 20 cases of gynecomastia. Clinical and Laboratory findings were normal. preoperatively patients are selected by their complaints, discomfort, psychological effects, shame, depression, anxiety and size of gynecomastia. In surgery, we have done is liposuction thoroughly after infiltration with adequate amount of ringer solution and Inj adrenaline 1:100000 concentration. In gynecomastia with group 1 and 2 we used websters incision, in group 2b we used extended websters incision if required. In very large gynecomastia with skin excess we have done breast reduction with liposuction and free nipple grafting in one case and medial pedicle based, superiorly based flap in two cases, two cases with circumareolar skin excision and liposuction in group 2 b case. In rest 16 cases we have done liposuction, excision through websters incision.Results: In our study of 20 cases done in two years, in our department of plastic surgery at NKPSIMS, one was unilateral and rest 19 were bilateral gynecomastia cases. In all cases liposuction as treatment modality used and has given satisfactory outcome in 18 (90%) cases out of 20, 3 (10%) cases want more liposuction and if possible re excision. Average hospital stay was 2 days. Post-operative recovery was good in majority cases but in 2 ((10%) cases post op numbness and ischemia at margin of areola occurred treated conservatively. In one case (5%). dehiscence of wound healed Conservatively. All cases of breast reduction were healed well. All cases benefited psychologically by surgery and their self-image in society improved lot.Conclusions: The problem of excessive fat and fibroglandular tissue is managed by liposuction and excision through websters incision. In high grade gynecomastia of grade 3 we have done breast reduction. This has corrected deformity, restoring normal contour to majority of patients and they improved psychologically, and their self-image improved and so their social life

Myelodysplastic syndromes/neoplasms: recent classification system based on World Health Organization Classification of Tumors – International Agency for Research on Cancer for Hematopoietic and Lymphoid Tissues

The myelodysplastic Syndromes (MDS) are a group of clonal hematopoietic stem cell diseases characterized by cytopenia(s), dysplasia in one or more of the major myeloid cell lines, ineffective hematopoiesis, and increased risk of development of acute myeloid leukemia. The classification and the diagnostic criteria have been redefined by the recent World Health Organization Classification of Tumors – International Agency for Research on Cancer for Hematopoietic and Lymphoid Tissues. The myelodysplastic syndromes are now classified into the following categories – refractory cytopenia with unilineage dysplasia, refractory anemia with ring sideroblasts, refractory cytopenia with multilineage dysplasia, refractory anemia with excess blasts, myelodysplastic syndrome associated with isolated del (5q), myelodysplastic syndrome – unclassifiable, and childhood myelodysplastic syndrome. The clinicopathologic features, morphology, differential diagnosis, immunophenotyping, cytogenetics, prognosis and predictive factors are presented in the light of recent World Health Organization Classification of Tumors – International Agency for Research on Cancer

Basal Cell Adenocarcinoma in the Tongue: An Unusual Presentation

We present a case of basal cell adenocarcinoma (BCAC) in the tongue in a 65-year old male. This is an extremely rare presentation. BCAC generally occurs in the parotid gland and rarely involves the minor salivary glands. Few cases have been reported in literature with a variable presentation. The biopsy was formalin-fixed and paraffin-embedded. The sections were stained with routine Hematoxylin and Eosin. Immunohistochemistry was performed. Hematoxylin and eosin staining showed tumour composed of variable sized and shaped, nests and sheets of basaloid epithelial cells having hyperchromatic to vesicular nuclei. Immunohistochemistry was positive for Pancytokeratin, Epithelial membrane antigen and p53. The clinicopathological features and the cellular immunophenotype addressed the diagnosis towards BCAC of the tongue. The goal of this report is to increase awareness of this rare disease and to review and discuss the differential diagnosis and important considerations in treatment

Internet addiction, behavioural aspects, and health related problems associated with it: a cross sectional study among engineering students of Jabalpur district

Background: With the rise of new generation gadgets, the risk of “internet addiction” is emerging as a significant behavioral addiction pandemic to be tackled worldwide. Internet addiction can be defined as an impulse disorder. Objective of the study was to determines the level of Internet addiction in Students. To identify the behavioural and any health-related problems associated with internet addiction among students.Methods: This study was a cross sectional study carried out in 7 different engineering colleges of Jabalpur city during the period of 1st July 2016 to 30th September 2016.Results: In present study the prevalence of internet addiction was found to be 74 %. 26 % of the participants were found with no internet addictions whereas 55 % and 17.67 % of the participants were found to be mild and moderate addicted whereas only 1.33 % of the participants were severely addicted to internet addiction. Participant who has internet addiction has 84.8 % of yelling and annoying behavior while 86.5 % participants with internet addiction have secretive and defensive behavior. Association was found to be highly significant (p = <0.001). Ill effects like problem related to eye have significant effect on the participants with internet addiction i.e. 66.17 %. Association of problem related to eye problems with internet addiction was significant with the p = 0.02.Conclusions: The problem is alarming and progressing to an addictive state in the near future Interventions like setting boundaries and detecting early warning signs of underlying psychopathology at the earliest are require

Effect of Sertraline on biomarker alterations in patients of multidrug resistant tuberculosis with depression: a prospective clinical trial

Background: Lipid profile parameters may be used as biomarker for depression. Sertraline belongs to selective serotonin reuptake inhibitors (SSRIs), the most commonly used group to treat the depression in multidrug resistant tuberculosis patients.Methods: A prospective clinical trial was carried out in department of Psychiatry and department of Tuberculosis and Respiratory disease G.S.V.M. Medical College, Kanpur. Diagnosed MDR TB patients were screened for depression applying Hamilton Depression Rating Scale (HDRS) and these patients were referred to Psychiatrist for diagnosis of depression. Total 25 diagnosed patients of MDR TB with mild to moderate depression were selected. HDRS Score and morning blood sample of 5ml were collected to analyze biomarker for depression before intervention. Same test was repeated in 18 patients who completed the study at day 30 and 120 after administering Sertraline (50mg). Data were compiled and analyzed using SPSS 20.0 and paired t - test.Results: The mean decrease in HDRS score from base line at day 30 and 120 of administering Sertraline were 6.22 (±1.26) and 2.72 (±0.67) which were significant (p˂0.001). The mean increase in serum cholesterol at day 30 was 153.94 (±19.31) and at day 120 was 157.83 (±19.36) which were significant (p˂0.001). Rest of Tg, HDLc, LDLc and VLDL cholesterole levels were not increased significantly.Conclusions: As the depression symptoms improved by sertraline. The biomarkers of depression were also increased (within the normal range) from baseline but significant increase was observed in serum cholesterol only

A Test between Plant and Fish Oil Sources: The Potential Benefits of Diet Enhanced with Omega-3 Fatty Acids

Skeletal muscle mediates 70-80% of glucose uptake. When the skeletal muscle’s capability to absorb glucose is reduced, the individual becomes insulin resistant and develops, if unabated, diabetes. Here we performed a high fat feeding study on inbred diet-induced obesity in C57BL/6 (B6) mice over the course of 12 weeks, in which we compared the well-established effects of omega-3 fatty acid (n-3) rich fish oil (FO) versus the poorly understood effects of balanced n-3 and omega-6 fatty acid (n-6) rich plant derived Echium oil (EO). Although there were little differences in HFEO or HFFO supplemented groups compared to the high fat control group with respect to blood glucose or plasma insulin concentrations, the Echium oil-enriched diet improved glucose tolerance by 12 weeks. Skeletal muscle was examined for diet-specific changes in insulin sensitivity, growth and survival signaling, and anti-inflammatory activity. We found that the n-3 supplemented high fat diet-fed mice, and especially the HFEO group, showed enhanced Akt1 activity, as well as increased GSK-3β phosphorylation and inactivation in the HFEO group, suggesting increased insulin signaling and glycogen synthesis. Although skeletal muscle PPARγ levels were not different among the high fat diet groups, BiP, a marker of ER stress, had a trend of being reduced in the HFEO group. Thus, the improved glucose tolerance of Echium oil-supplemented high fat diet-fed mice were due to changes in skeletal muscle physiology resulting in enhanced insulin sensitivity and reduced ER stress

Pseudosarcomatous myofibroblastic proliferations of the genitourinary tract are genetically different from nodular fasciitis and lack USP6, ROS1 and ETV6 gene rearrangements

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145266/1/his13526_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/145266/2/his13526.pd

The interplay of growth differentiation factor 15 (GDF15) expression and M2 macrophages during prostate carcinogenesis

M2 (tumor-supportive) macrophages may upregulate growth differentiation factor 15 (GDF15), which is highly expressed in prostate tumors, but the combined utility of these markers as prognostic biomarkers are unclear. We retrospectively studied 90 prostate cancer cases that underwent radical prostatectomy as their primary treatment and were followed for biochemical recurrence (BCR). These cases also had a benign prostate biopsy at least 1 year or more before their prostate cancer surgery. Using computer algorithms to analyze digitalized immunohistochemically stained slides, GDF15 expression and the presence of M2 macrophages based on the relative density of CD204- and CD68-positive macrophages were measured in prostate: (i) benign biopsy, (ii) cancer and (iii) tumor-adjacent benign (TAB) tissue. Both M2 macrophages (P = 0.0004) and GDF15 (P \u3c 0.0001) showed significant inter-region expression differences. Based on a Cox proportional hazards model, GDF15 expression was not associated with BCR but, in men where GDF15 expression differences between cancer and TAB were highest, the risk of BCR was significantly reduced (hazard ratio = 0.26; 95% confidence interval = 0.09-0.94). In addition, cases with high levels of M2 macrophages in prostate cancer had almost a 5-fold increased risk of BCR (P = 0.01). Expression of GDF15 in prostate TAB was associated with M2 macrophage levels in both prostate cancer and TAB and appeared to moderate M2-macrophage-associated BCR risk. In summary, the relationship of GDF15 expression and CD204-positive M2 macrophage levels is different in a prostate tumor environment compared with an earlier benign biopsy and, collectively, these markers may predict aggressive disease