Role of Tc-99m pertechnetate thyroid scintigraphy in evaluation of lingual and midline neck swellings

Background: The ectopic thyroid tissue in thyroglossal cyst or suprahyoid swelling is one of most important differential to be diagnosed. The purpose of this study was to find out role of Technetium-99m Pertechnetate Thyroid Scintigraphy (TS) to detect functioning thyroid tissue in ectopic locations presenting as midline neck swelling.Methods: A retrospective observational study was done where 26 subjects presenting with midline neck swelling were included. These subjects were injected with 1-5MBq/kg of Technetium-99m Pertechnetate to perform the TS. The uptake of tracer in the midline neck swelling and in other ectopic location was assessed. The comparison with Ultrasound (USG) was also done.Results: 12 (46.15%) subjects presented with infra hyoid swelling and rest 14 (53.85%) presented with supra hyoid and submental swelling. 33.3% subjects presenting with thyroglossal duct cyst showed functioning thyroid tissue. Also 4 subjects showed dual functioning ectopic tissue. USG an TS showed concordant results for detecting thyroid tissue in ectopic location (p=0.68). However, TS performed better to detect ectopically located thyroid tissue (p=0.0086).Conclusions: USG and TS showed similar results to detect thyroid tissue in normal location. However, TS is better to detect topically located thyroid tissue. TS adds information of functioning thyroid tissue during workup of midline neck swelling.

Liquid gastric emptying time 1/2 in infants: establishing reference range and it’s co-relation with presence of gastro-esophageal reflux

Background: Gastric emptying time ½ (GET ½) is considered as the half time taken for chyme to pass into the duodenum. Gastric emptying depends upon numerous factors, both endogenous and exogenous. Nerve and hormones along with volume of meal, pH, particle size, composition and viscosity play part in gastric emptying. Aim of the study was to determine liquid gastric emptying Time ½ in infants and to evaluate impact of positive GER on Gastric Emptying Time.Methods: Total 149 full term babies from 29th day to 1 year of age; underwent Tc-99m labeled with Sulfur colloid GER scintigraphy using age specific formula. Babies with gastro-intestinal anomalies, lactose intolerance and low birth weight babies were excluded. The reference range of GET ½ was estimated from GER negative group and the same was compared with GER positive group.Results: Out of 149 babies 96 (64%) babies were GER positive and 53 (36%) were negative for GER. The liquid GET ½ values generated for 29th day-3 months, 4-6 months, 7-9 months and 10 months -1year were 62.67 (12.42), 69.84 (13), 63.5 (9.7) and 53.2 (10) minutes respectively. The liquid GET½ was found to be delayed in severe GER positive group.Conclusions: The reference range for liquid GET½ was estimated from GER negative group utilizing the exclusion criteria thereby avoiding radiation exposure to normal controls. With increasing severity of GER there was consequent prolongation of liquid GET½

Peroxisome proliferator-activated receptors and thiazolidinediones in diabetic nephropathy

Diabetic nephropathy is global problem with several drugs into trial without much success the current article highlights the role of thiazolidinedione’s in diabetic nephropathy by scrutinizing and reconnoitring the cellular and intracellular mechanism and shielding action and the role of peroxisome proliferator-activated gamma receptors (PPARγ) receptors. Not only anti-diabetic action but renal protective effect with evidence based study has been highlighted. PPAR γ-is versatile target having numerous benefits and mainly preventing fibrosis in diabetic experimental model and some clinical case report yet, the benefits are not up to mark, since renal failure itself causes volume expansion and the thiazolidinedione’s (TZDs) also preserve salt and water and lead to congestive heart failure which constraints its clinical application. Dual activators and balaglitazone selective PPAR modulator are having upcoming potential for treatment of diabetic nephropathy. Further detail investigation on such drug is needed to explore. However adverse effect like heart failure, osteoporosis and volume expansion effect over-rides the beneficial effect thus limiting its clinical use of currently available TZDs

Randomized Clinical Trial of High-Dose Rifampicin With or Without Levofloxacin Versus Standard of Care for Pediatric Tuberculous Meningitis: The TBM-KIDS Trial

Background. Pediatric tuberculous meningitis (TBM) commonly causes death or disability. In adults, high-dose rifampicin may reduce mortality. The role of fluoroquinolones remains unclear. There have been no antimicrobial treatment trials for pediatric TBM. Methods. TBM-KIDS was a phase 2 open-label randomized trial among children with TBM in India and Malawi. Participants received isoniazid and pyrazinamide plus: (i) high-dose rifampicin (30 mg/kg) and ethambutol (R30HZE, arm 1); (ii) high-dose rifampicin and levofloxacin (R30HZL, arm 2); or (iii) standard-dose rifampicin and ethambutol (R15HZE, arm 3) for 8 weeks, followed by 10 months of standard treatment. Functional and neurocognitive outcomes were measured longitudinally using Modified Rankin Scale (MRS) and Mullen Scales of Early Learning (MSEL). Results. Of 2487 children prescreened, 79 were screened and 37 enrolled. Median age was 72 months; 49%, 43%, and 8% had stage I, II, and III disease, respectively. Grade 3 or higher adverse events occurred in 58%, 55%, and 36% of children in arms 1, 2, and 3, with 1 death (arm 1) and 6 early treatment discontinuations (4 in arm 1, 1 each in arms 2 and 3). By week 8, all children recovered to MRS score of 0 or 1. Average MSEL scores were significantly better in arm 1 than arm 3 in fine motor, receptive language, and expressive language domains (P < .01). Conclusions. In a pediatric TBM trial, functional outcomes were excellent overall. The trend toward higher frequency of adverse events but better neurocognitive outcomes in children receiving high-dose rifampicin requires confirmation in a larger trial. Clinical Trials Registration. NCT02958709

Management of sequalae of neglected septic shoulder

Complex deformities following septic arthritis of the shoulder in infancy are mild and therefore rarely reported. A 12 year old girl presented with shortening of upper extremity right side, with dislocation of shoulder and with entire extremity rotated to 180 degrees. The palm faced posteriorly and the olecranon anteriorly. Arthrodesis of shoulder and unifocal lengthening of humerus was achieved with three 4 mm cannulated cancellous screws and an ilizarov frame. A lengthening of 9 centimeters was achieved and regenerate healed at 12 months. At 10 years follow-up she is able to perfom her activities of daily living

INDIGENOUS KNOWLEDGE OF LOCAL COMMUNITIES OF MALWA REGION ON SOIL AND WATER CONSERVATION

ABSTRACT: After half a century of failed soil and water conservation projects in tropical developing countries, technical specialists and policy makers are reconsidering their strategy. It is increasingly recognized in Malwa region that the land users have valuable environmental knowledge themselves. This review explores two hypotheses: first, that much can be learned from previously ignored indigenous soil and water conservation practices; second, that can habitually act as a suitable starting point for the development of technologies and programmes. However, information on ISWC (Indigenous Soil and Water Conservation) is patchy and scattered. Total 14 indigenous Soil and water Conservation practices have been identified in the area. Result showed that these techniques were more suitable accord to geographic location

Three component cartilage framework reconstruction for correction of post-traumatic nasal septal collapse

Background: Post-traumatic nasal septal collapse results in flat, broad, non-projecting nose due to mid-vault collapse. These patients may have airway obstruction due to poorly supported internal valve. Traditional techniques like ‘cantilever graft technique’ or conventional ‘L-graft technique’ produce a rigid lobule as the single unit framework extends to the tip. These grafts also lack in internal valve support. Materials and Methods: Twelve patients with post-traumatic nasal septal collapse were treated with three component cartilage framework technique in the past 3 years. The framework was reconstructed in three components-septal, columellar and dorsal onlay; using costal cartilage. If needed, upper lateral cartilage support grafts were also provided. Results: At 6 months’ follow-up, all 12 patients were satisfied with the outcome. The nasal projection and dorsal definition were aesthetically pleasing, and there was free natural movement of the lobular part of the nose. One graft was revised for further improvement in outcome. Airway obstruction, when present was also relieved. Conclusion: This technique has distinct advantages over the conventional techniques as the framework of separate components maintains pliability of the lobule, supports the internal valve and offers good control of aesthetic needs

Role of Tc-99m pertechnetate thyroid scintigraphy in evaluation of lingual and midline neck swellings

Background: The ectopic thyroid tissue in thyroglossal cyst or suprahyoid swelling is one of most important differential to be diagnosed. The purpose of this study was to find out role of Technetium-99m Pertechnetate Thyroid Scintigraphy (TS) to detect functioning thyroid tissue in ectopic locations presenting as midline neck swelling.Methods: A retrospective observational study was done where 26 subjects presenting with midline neck swelling were included. These subjects were injected with 1-5MBq/kg of Technetium-99m Pertechnetate to perform the TS. The uptake of tracer in the midline neck swelling and in other ectopic location was assessed. The comparison with Ultrasound (USG) was also done.Results: 12 (46.15%) subjects presented with infra hyoid swelling and rest 14 (53.85%) presented with supra hyoid and submental swelling. 33.3% subjects presenting with thyroglossal duct cyst showed functioning thyroid tissue. Also 4 subjects showed dual functioning ectopic tissue. USG an TS showed concordant results for detecting thyroid tissue in ectopic location (p=0.68). However, TS performed better to detect ectopically located thyroid tissue (p=0.0086).Conclusions: USG and TS showed similar results to detect thyroid tissue in normal location. However, TS is better to detect topically located thyroid tissue. TS adds information of functioning thyroid tissue during workup of midline neck swelling.

Liquid gastric emptying time 1/2 in infants: establishing reference range and it's co-relation with presence of gastro-esophageal reflux

Background: Gastric emptying time ½ (GET ½) is considered as the half time taken for chyme to pass into the duodenum. Gastric emptying depends upon numerous factors, both endogenous and exogenous. Nerve and hormones along with volume of meal, pH, particle size, composition and viscosity play part in gastric emptying. Aim of the study was to determine liquid gastric emptying Time ½ in infants and to evaluate impact of positive GER on Gastric Emptying Time.Methods: Total 149 full term babies from 29th day to 1 year of age; underwent Tc-99m labeled with Sulfur colloid GER scintigraphy using age specific formula. Babies with gastro-intestinal anomalies, lactose intolerance and low birth weight babies were excluded. The reference range of GET ½ was estimated from GER negative group and the same was compared with GER positive group.Results: Out of 149 babies 96 (64%) babies were GER positive and 53 (36%) were negative for GER. The liquid GET ½ values generated for 29th day-3 months, 4-6 months, 7-9 months and 10 months -1year were 62.67 (12.42), 69.84 (13), 63.5 (9.7) and 53.2 (10) minutes respectively. The liquid GET½ was found to be delayed in severe GER positive group.Conclusions: The reference range for liquid GET½ was estimated from GER negative group utilizing the exclusion criteria thereby avoiding radiation exposure to normal controls. With increasing severity of GER there was consequent prolongation of liquid GET½

Outcome of single level instrumented posterior lumbar interbody fusion using corticocancellous laminectomy bone chips

Background: Interbody fusion surgery has been considered by many to be a treatment of choice for instability in lumbar degenerative disc disease. A posterior lumbar interbody fusion (PLIF) has the advantages of spinal canal decompression, anterior column reconstruction, and reduction of the sagittal slips from a single posterior approach. The PLIF using double cage was a standard practice till many studies reported comparable results and lesser complications with single cage. Iliac crest was considered as an appropriate source of bone graft until comparable spinal fusion rates using local bone graft and cage emerged. Till date, there has been no report of corticocancellous laminectomy bone chips alone being used for spinal fusion. In this paper, we present radiologic results of single level instrumented PLIF, where in only corticocancellous laminectomy bone chips were used as a fusion device. Materials and Methods: It is a retrospective cohort study of 35 consecutive patients, who underwent single level instrumented PLIF surgery, wherein only locally obtained bone chips was used for spinal fusion. The average follow-up was 26 months. The indications for the surgery were as follows: 19 patients had disc herniations, with back pain of instability type, normal disc height on radiology. Ten patients had grade 1 spondylolisthesis, with significant back pain and translational instability on radiography. Three patients were redo spine surgeries, and three patients had healed spondylodiscitis with significant back pain and instability. All patients were regularly followed up and decision of spinal fusion or no fusion was taken at 2 years using modified criteria of Lee. Results: Of total 35 patients, there were 24 males and 11 females, with a mean age of 41 years. There were 16 patients with definitive fusion, 15 patients with probable fusion, 04 patients with possible pseudoarthrosis, and no patient had definitive pseudoarthrosis. The mean time for fusion to occur was 18 months. The average loss of disc height, over 2 year follow up, was only 3 mm in 8 patients. Three patients had a localized kyphosis of more than 3° at the fusion level. The average blood loss was 356 ml and average operating time was 150 min. Conclusion: Corticocancellous laminectomy bone chips alone can be used as a means of spinal fusion in patients with single level instrumented PLIF. This has got a good fusion rate