Ophthalmology

Management of restrictive strabismus Karim Gaballah Journal of the Egyptian Ophthalmological Society 2019 112(1):1-8 Aim of the study This study aimed to target a special type of strabismus, the restrictive type, with prediction of its problems, diagnostic, management, and results. Patients and methods This is a prospective randomized study performed in Alexandria. The participants of this study were 42 patients having restricted strabismus, with different diagnostic criteria, such as abnormal ocular deviation with the movement of the globe defective and not reaching the midline, abnormal position of the head, forced duction test, and anatomical changes found during surgery. Results The cases of restrictive strabismus included congenital cases including monocular elevation deficit, Brown’s syndrome, congenital fibrosis of extraocular muscles, oculomotor nerve palsy, and long-standing strabismus, especially unilateral presenting in old age. Cases needed specific diagnostic procedure such as forced duction test to be performed preoperatively and intraoperatively, and postoperative results were satisfactory in most cases except cases that underwent previous surgery with muscle resection, aggravating the condition and leading to more restrictions. Conclusion Cases of restrictive strabismus, when properly diagnosed, with special considerations, could arrive at a postoperative satisfactory outcome.

Effect of Ex-PRESS glaucoma filtration device on corneal endothelium in primary open-angle glaucoma Dina Abd El Fattah Abd El Rehim, Abd-Almonem Abo-Alfotouh El-Hessy, Sherif El-Saeed El-Kholy, Ehab Hassan Nematalla, Eglal Mohamed El-Saeed Journal of the Egyptian Ophthalmological Society 2019 112(1):9-13 Purpose The aim of this study is to compare the effect of Ex-PRESS minishunt versus standard trabeculectomy on corneal endothelial cell count (ECC) in cases of primary open-angle glaucoma. Setting This comparative prospective nonrandomized study was conducted at Mansoura Ophthalmic Center, Mansoura University, Mansoura, Egypt. Patients and methods The study included 36 eyes of 25 patients with uncontrolled primary open-angle glaucoma. Nineteen eyes had Ex-PRESS glaucoma minishunt and 17 eyes had trabeculectomy. Specular microscopy was used to measure ECC using TOMEY EM-3000. ECC was measured preoperatively and compared with postoperative values at 6 and 12 months. Results The mean endothelial cell density was 2493.2±246.8 cells/mm2 before the surgery in the Ex-PRESS group and 2473.8±259.8 cells/mm2 in the trabeculectomy group (P=0.82). This value decreased significantly in both groups at 12 months postoperatively to 2348.1±309.5 in the Ex-PRESS group and 2276.1±342.4 in the trabeculectomy group. ECC loss at 1 year was less in the Ex-PRESS group at 5.7 versus 8% in the trabeculectomy group (P=0.051). Conclusion Ex-PRESS minishunt is considered a safe procedure regarding corneal endothelium, showing less decrease in ECC than conventional trabeculectomy.

Comparative study between the effects of different concentrations of methylcellulose on the corneal endothelium during phacoemulsification Sherif M Akef Saleh, Rafiq M.F ELGhazawy, Amr I.S ElAwamry, Rania G Zaki Afifi Journal of the Egyptian Ophthalmological Society 2019 112(1):14-24 Purpose To study the effect of different concentrations of methylcellulose on the corneal endothelium during phacoemulsification using specular microscopy. Patients and methods Sixty patients with immature senile cataract were equally distributed into two groups according to the concentrations of hydroxypropyl methylcellulose (HPMC) used during phacoemulsification surgeries. In the first group, HPMC 2% was used, and in the second group, HPMC 2.4% was used. Preoperative and 1-month postoperative evaluations were done including visual acuity testing, slit lamp examination using Topcon SL-3C, intraocular pressure measurement using Goldmann Applanation Tonometer, fundus examination, and corneal endothelium assessment by Tomey Specular Microscope EM-3000. Results Preoperatively, no significant difference was recorded in age, sex, visual acuity, intraocular pressure, and endothelial cell count among the two groups. Postoperatively, the two groups had a significant decrease in endothelial cell count, but the decrease was less in group 2 using methylcellulose 2.4% (13.494%) than in group 1 using methylcellulose 2% (14.515%). There was an equal and significant improvement in visual acuity in the two groups. Conclusion Methylcellulose 2.4% and methylcellulose 2% were comparable in their ability to protect the corneal endothelium during phacoemulsification; in general, both viscoelastics can be effeciently and safely used in performing phacoemulsification.

Visual and keratometric outcomes in eyes undergoing small incision lenticule extraction for compound myopic astigmatism Ashraf H Soliman Journal of the Egyptian Ophthalmological Society 2019 112(1):25-29 Context The use of small incision lenticule extraction (SMILE) for compound myopic astigmatism has been subject to experimentation in the recent years. Furthermore, examination of corneal alterations has revealed conflicting conclusions, which could be attributable to demographic variation. Aims The aim of this study was to measure visual and keratometric efficacy of SMILE and correlate spherical equivalent (SE) decrements to keratometric alterations. Settings and design This was a prospective nonrandomized study. Thirty eyes of 15 patients were included in the study. Preoperative assessment included oculus Pentacam analysis. Patients were followed-up for up to 3 months, after which tomography was repeated. Statistical analysis used Descriptive statistics, t test, and linear regression analysis were carried out. Results There was a statistically significant improvement in postoperative uncorrected distance visual acuity and SE and a statistically significant change in Q value (P<0.001). The mean residual SE postoperatively was −0.14 D. A highly statistically significant negative correlation existed between SE difference and mean K difference with r=−0.980 and P value less than 0.001, and a highly statistically significant positive correlation existed between SE difference and Q value difference, with r=0.787 and P value less than 0.001. Conclusion SMILE is a safe and effective technique to correct cases with myopic astigmatism with an SE of up to −10 D, and a predictable positive correlation could be established between decrements in SE and decrements in anterior corneal steepening.

Correlation between axial length and anterior chamber depth in short eyes, normal eyes, and long eyes Rafik M.F El-Ghazawy, Amr I El-Awamry, Rania G Zaki, Joseph H.F Aziz Journal of the Egyptian Ophthalmological Society 2019 112(1):30-33 Context Accurate intraocular lens (IOL) power calculation is mandatory to achieve satisfactory refractive outcomes. Axial length, keratometric readings, anterior chamber depth, and other measurements are utilized to estimate postoperative effective lens position. Selecting the formula of IOL calculation depends mainly on axial length (AL) and anterior chamber depth (ACD). Aims To study the correlation between AL and ACD in short, normal, and long eyes. Settings and design The study was conducted at Ain Shams University Hospitals after the approval of the research ethics committee in the Faculty of Medicine, Ain Shams University. Study period: 6 months. Patients and methods The study included 90 eyes of patients presented for IOL or phakic lens implantation. They were divided into three groups according to the AL. Group A included 30 patients with short AL of less than or equal to 22 mm. Group B included 30 patients with normal AL of more than 22 mm and less than 24.50 mm. Group C included 30 patients with long AL of more than or equal to 24.50 mm. The AL and ACD of each patient were measured using The ZEISS IOL Master 500. Statistical analysis used The Statistical Package for the Social Sciences, version 24. Results The results of our study showed that the correlation between the axial length and the anterior chamber depth among short eyes was statistically significant and they were negatively correlated, while no statistically significant correlation existed between AL and ACD in normal and long eyes. Conclusion The AL and ACD are inversely related in short eyes with an AL of less than or equal to 22 mm, while no correlation exists in normal and long eyes with an AL of more than 22 mm.

Early detection of glaucoma suspect by pattern electroretinogram Heba A.M Hassan, Reham F Abdelrazek El-Shinawy, Abd El R.G Salman, Marwa E Elsbaay Journal of the Egyptian Ophthalmological Society 2019 112(1):34-38 Aim This study was intended to estimate the significance of pattern electroretinogram (PERG) in evaluation of the retinal ganglion cell function in patients with glaucoma. Patients and methods An observational case–control study was done on 40 eyes of individuals whose age ranged between 30 and 65 years of age. They were divided into two equal groups. Control group had normal visual field and optical coherence tomography optic nerve, intraocular pressure (IOP) less than 21 mmHg, visual acuity more than 0.3, and cup disc ratio (C/D) less than 0.5. The case group was divided into two equal subgroups: group A had IOP more than 21 mmHg and C/D less than 0.5, and group B had IOP less than 21 mmHg and C/D more than 0.5. We excluded all cases with ocular or systemic diseases with negative effect on retinal function such as retinal detachment, retinitis pigmentosa, rheumatoid arthritis on hydroxychloroquine, diabetic patients on insulin or oral hypoglycemic, or cases with abnormal optic disc appearance such as optic disc drusen, coloboma, or tilted disc. All cases underwent full ophthalmological examination, including best-corrected visual acuity, complete anterior segment examination with slit-lamp biomicroscopy, and posterior segment examination using volk 90 D lens, along with IOP measurement using Goldmann applanation tonometer. Visual field assessment was done using Heidelberg Edge Perimeter, optical coherence tomography optic nerve using Heidelberg engineering, and glaucoma screening with ERG using glaucoma screening program. Results There was a highly statistically significant difference between the groups regarding C/D and IOP. Regarding the PERG and different visual fields parameters, there was a highly statistically significant difference between the groups. There was a statistically significant negative correlation between PERG and both IOP and VF parameters in all different groups. No statistically significant correlation was found between PERG and C/D in all different groups. Conclusion PERG has a prognostic value in recognition of retinal ganglion cell dysfunction, as an early indication for glaucoma development.

Social Health and Behavior

Poor Activities of Daily Living Function Reflect Poor Quality of Life after Hip Fracture Surgery for Geriatric Patients Wei-Ting Chang, Yi-Jie Kuo, Yu-Yun Huang, Ming-Jr Tsai, Yu-Pin Chen Social Health and Behavior 2019 2(2):41-46 Introduction: With the aging of the population, hip fractures have become a major public health issue in the elderly. It is important to examine the loss of activities of daily living (ADL) and the quality of life (QoL) among the elderly after repair of hip fracture. The correlation between ADL and QoL over time after hip fracture surgery was also our major concern. Methods: A prospective study enrolling 117 geriatric patients undergoing hip fracture surgery in a tertiary medical center was conducted between 2017 and 2018. All participants were evaluated with the EuroQol-5D for assessing QoL and the Barthel index for measuring ADL function at baseline, 3-and 6-month follow-ups after hip fracture surgery. Results: The mortality rate among geriatric patients after hip fracture surgery was 5.5% at 3 months and 9.1% at 6 months. In addition, both ADL function and QoL significantly deteriorated after 6 months of follow-up without improvement with time. After the 6-month follow-up, only 20% of geriatric patients undergoing repair for hip fracture were able to recover baseline ADL. The QoL at the 6-month follow-up was correlated with both cross-sectional and longitudinal ADL function after repair for hip fracture among geriatric patients. Conclusion: Functional impairment is common among geriatric patients after hip fracture surgery. Poor ADL could predict and reflect poor QoL after the 6-month follow-up. More emphasis should be put on preventing functional loss after hip fracture surgery in order for better QoL among geriatric patients undergoing hip fracture surgery.

Socioeconomic Inequality of Elder Abuse in Qazvin, Iran Zahra Hosseinkhani, Farzad Khodamoradi, Sara Sheikh Social Health and Behavior 2019 2(2):47-51 Introduction: Socioeconomic status (SES) is often associated with elder abuse. This study aimed to determine SES inequality of elder abuse in Qazvin, Iran. Methods: In this cross-sectional study, 683 (60–95 years) elders were included in the analysis in 2015. Hwalek-Sengstock Elder Abuse Screening Test was used to collect data on elder abuse. SES was measured through an asset-based method and principal component analysis. The concentration index and curve were used to measure SES inequality. Results: The concentration index for socioeconomic inequality of elder abuse was −0.0290 (95% confidence interval [CI]: −0.0498, −0.0081). This index based on residence showed elder abuse is more concentrated among rural elders with lower SES (C = −0.0739, 95% CI: [−0.112, −0.0356]). Conclusion: There is a slightly socioeconomic inequality of elder abuse among elders. Lower SES might be considered as a risk factor for elder abuse. Policymakers should plan for improvement in services to consider the role of SES in elder abuse.

Effect of Peer Education on Physical Activity and Nutrition among Iranian Adolescents Ali Damghanian, Gazal Sharietpanahi, Azita Khieltash, Hamid Barahimi Social Health and Behavior 2019 2(2):52-57 Introduction: Due to the high prevalence of sedentary lifestyle and inappropriate nutrition among adolescents, the present study aimed to investigate the effect of peer-based education on physical activity and nutrition among adolescents. Methods: In a randomized field trial with control group, a total of 223 students with a mean age of 16.52 (0.9) years participated in the study. Students were randomly selected from four high schools of Tehran's 17th district, Iran, using the multistage clustered sampling method. Two females and two males high schools were randomly assigned as an intervention or a control group. After selecting peer educators, they were educated about nutrition and physical activity at two 90-min sessions. Then, peer educators were asked to educate their classmates. Data were collected using demographic, nutrition, and physical activity subscales of Health Promoting Lifestyle Profile-II before and 3 months after the intervention. Data were analyzed using analysis of covariance in SPSS version 24 (IBM Corp., Armonk, New York). Results: Peer-based education improved girl's physical activity mean scores (16.19 ± 4.07–19.74 ± 4.25, P > 0.001), but no statistically significant effect on their nutrition. No statistically significant effect was observed after intervention on the nutritional status and physical activity of the male students. Conclusion: Peer education seemed to be a good method to improve physical activity among female students, but not their nutrition. In addition, physical activity and nutrition of male students were not improved by the peer education. Therefore, the future research using multidisciplinary approach which targets family involvement, and changes in physical activity and school nutrition policies are needed.

Mental Health and Its Sociodemographic Determinants among High School Students: A Cross-Sectional Survey in Qazvin City of Iran Mehran Alijanzadeh Social Health and Behavior 2019 2(2):58-63 Introduction: Adolescence is one of the most important stages of human life, and there is a lot of evidence in the literature that psychiatric disorders can be transmitted through adolescence social interactions in high school. The present study aimed to assess mental health and its sociodemographic determinants among high school students in Iran. Methods: In this cross-sectional study, 600 female high school students from Qazvin were selected using cluster sampling. The 28-item General Health Questionnaire was administrated to collect data. t-tests, analysis of variance, and Pearson's correlation analysis were applied to analyze the data. Results: Mental disorders were found in 60% of the students with 3.3% suffered from severe disorders. The participants' mean score of mental health was 29.31 ± 14.63. Somatic symptoms, anxiety, social dysfunction, and depression were presented in 36%, 49.7%, 50%, and 41.3% of the students, respectively. Students' mental health was significantly related with their father's education and household income. However, students' season of birth, school grade, body mass index, grade point average, mother's education, and father's occupation were not significantly related with their mental health. Conclusion: Poor mental health was found to be highly frequent among female students. Low income and father's low education level were identified as the risk factors of poor mental health among female students in Qazvin.

The Effect of Mothers' Group Counseling on the Health-Promoting Behaviors of Adolescent Girls Monireh Pourshamsian, Maryam Mafi, Nezal Azh Social Health and Behavior 2019 2(2):64-69 Introduction: Promoting adolescents' healthy behaviors through different strategies is essential to prevent the risks of adulthood chronic problems. This study aimed to investigate the effect of mothers' group counseling on the health-promoting behaviors of high school adolescent girls in Qazvin city, Iran. Methods: This single-blind, randomized controlled trial was conducted in Qazvin, Iran. Participants were 100 guidance school female students and their mothers who were selected through multistage random sampling. The demographic data form and Health Promoting Lifestyle Profile were used for data collection before and 2 months after the intervention. The intervention was conducted in four sessions lasting for 90–60 min. Results: There was no improvement in the mean score of health-promoting behaviors before the intervention in the control group (27 ± 20.313) and the intervention group (23.54 ± 138.86), but after the intervention in the intervention group, a significant improvement was observed with a mean difference of 12.90 in the intervention group whereas 5.26 in the control group. The highest increase was in stress and nutrition control with a mean difference of 3.06 and 2.74, respectively. The ANCOVA test also confirmed the effectiveness of education (P = 0.03, F = 4.43). Conclusion: Mothers' group counseling can improve adolescent health-promoting behaviors. Considering the importance of the role of mothers in protecting and promoting the health of adolescent girls, it is essential that maternal education and counseling are prioritized to increase the healthy behaviors of adolescent girls.

Lifestyle and Preventive Behaviors of Osteoporosis among Women of Reproductive Age in Qazvin-Iran: A Cross Sectional Study Leili Yekefallah, Leila Dehghankar, Mohaddeseh Aliakbari, Maryam Mafi Social Health and Behavior 2019 2(2):70-75 Introduction: Osteoporosis is a silent illness with many negative consequences that can decrease women's quality of life and daily life activities and even cause death. The aim of this study was to examine the lifestyle and preventive behaviors related to osteoporosis among women of reproductive age in Qazvin city, Iran. Methods: In this cross-sectional study, 300 women (mean age = 30.75 ± 7.47 years) were selected using the stratified cluster sampling method. A researcher-made questionnaire consisting of 15 questions on the patterns of nutrition, physical activity, and specific preventive behaviors related to osteoporosis and demographic factors was used for data collection. Data were analyzed using Chi-square with Fisher's exact test and logistic regression model. Results: The study results showed that most women (73.3%) had a positive family history of osteoporosis and 65.3% of them consumed carbonated beverages at least twice a week. Furthermore, 46.7% of them used coffee twice a week. There was a statistically significant relationship between their age (P < 0.0001) and positive family history of osteoporosis (P = 0.05) with knowledge about osteoporosis. According to the logistic regression model, a statistically significant relationship was found between age and awareness of osteoporosis (P = 0.001). Conclusion: Women should be encouraged to change their lifestyle in order to prevent osteoporosis. Educational programs should be held, and educational posters should be installed in gathering areas in the city and health centers with regard to risk factors and preventive behaviors of osteoporosis among women of reproductive age.

Diabetology

HIV and antiretroviral therapy-induced metabolic syndrome in people living with HIV and its implications for care: A critical review Sakhile Khetsiwe Salome Masuku, Joyce Tsoka-Gwegweni, Ben Sartorius Journal of Diabetology 2019 10(2):41-47 HIV has remained a major global public health concern for more than three decades. While global efforts are coalesced in the fight against HIV, the number of people living with HIV (PLHIV) is continuously increasing due to the rollout of antiretroviral therapy (ART). This relates, in part, to the intensified efforts in HIV prevention and control strategies through extensive HIV testing. Consequently, more and new people have learnt their HIV-positive status, implying that more are at risk of suffering the negative effects of HIV and ART. HIV has been implicated in the development of many non-communicable diseases such as cardiovascular diseases and type 2 diabetes mellitus (T2DM). This study conducted a critical review of the literature on the mechanisms through which HIV and ART cause metabolic syndrome, and the implications such understanding has to the care provided to PLHIV. The findings of this review suggest that HIV induces metabolic syndrome through stimulation of immune cells which, in turn, trigger an inflammatory response. ART also triggers the inflammatory response. The inflammatory response suppresses adiponectin and causes impaired insulin action on skeletal muscles. Since the presence of metabolic syndrome greatly increases the risk of non-communicable diseases, particularly T2DM, there is a need for metabolic syndrome screening and prevention among PLHIV. Conducting routine body mass index and waist circumference measurement with periodical triglycerides measurement is necessary for the early detection of metabolic syndrome and the prevention of T2DM and cardiovascular conditions. There is also a need for a model of care for PLHIV that will provide guidance on the prevention of metabolic syndrome hence prevent the development of T2DM with its dire effects on the quality of life.

Can decreased heart rate variability be a marker of autonomic dysfunction, metabolic syndrome and diabetes? Gunjan Y Trivedi, Banshi Saboo, Ram B Singh, Anuj Maheshwari, Kamal Sharma, Narsingh Verma Journal of Diabetology 2019 10(2):48-56 Epidemiological studies show an emergence of diet- and lifestyle-related diseases; Cardio-metabolic diseases (CMD) and neuropsychiatric diseases (classified as non-communicable diseases or chronic diseases). Diet and lifestyle factors can cause adverse effects on autonomic function resulting in decreased heart rate variability (HRV). Low HRV is a risk factor for CMDs. There is a need to find out new methods of early diagnosis for prevention and treatment of these problems because the neurohormonal dysfunction could be the earliest manifestation. It is possible that HRV could be a marker for the early diagnosis of these problems, because it is characterised with increased sympathetic and reduced parasympathetic activity. Several studies indicate that increased unhealthy diet, mental stress, sedentary lifestyle, tobacco, insomnia and alcoholism may be associated with neurohormonal dysfunction, which may cause decline in HRV. Majority of the chronic diseases (e.g., diabetes, hypertension, heart attack, neuropsychiatric disease and cancer) are associated with decreased HRV. The studies also indicate that solar and geomagnetic activities may influence circadian clock and hypothalamus resulting in the oxidative stress and inflammation with alteration in HRV. It is possible that reduced HRV will correlate with various stages of autonomic dysfunction, associated with chronic diseases. Simple methods need to be developed to measure HRV for early diagnosis of neurohormonal dysfunction, which may be important for early management. This review aims to find out available evidence on the role of HRV in the early diagnosis of chronic disease (with specific focus on Type 2 diabetes) and the factors affecting HRV.

Implications of CVD-REAL 2 study for Indian diabetic population Rajeev Chawla, Shalini Jaggi Journal of Diabetology 2019 10(2):57-61 South Asians are reported to have a higher risk of developing macrovascular complications of Diabetes, i.e., coronary artery and cerebrovascular diseases as compared to Caucasians. Literature evidence has shown that among the currently available agents, the sodium/glucose cotransporter 2 inhibitors (SGLT2i) offer a rational approach for management of T2DM over other glucose lowering therapies because of their insulinindependent action, modest weight loss, mild reduction in BP and low risk of hypoglycaemia. Recently, CVDREAL 2 study was conducted across six countries (Israel, Canada, South Korea, Japan, Singapore and Australia) to determine the CV benefits of various SGLT2i in >400,000 T2DM patients in a realworld scenario. Around 75% of the patients in this study were from the AsiaPacific region. Among all the available SGLT2i, most of the study population was exposed to dapagliflozin, contributing to 75% of the total exposure time. The CVDREAL 2 study favoured SGLT2i over other glucose lowering drugs for lower risk of death, HHF, MI and stroke. All these points suggest that the results of CVDREAL 2 study can be incorporated in the high CVD risk Indian population who need much more aggressive treatment for diabetes than other patient populations.

Quality evaluation of speciality rice varieties available in South Indian (Chennai) market Ramalingam Anjana, Haripriya Ashok Kumar, Ranjit Unnikrishnan, Ranjit Mohan Anjana, Shanmugam Shobana, Vishwanathan Mohan, Vasudevan Sudha Journal of Diabetology 2019 10(2):62-68 Background: Several speciality rice with health claims are emerging in the south Indian market. The study aims to examine the nature of speciality rice with health claims available in the Chennai market. Methodology: A market survey was conducted in randomly selected outlets from 4 zones of the Chennai city urban market (100 stores including supermarkets/hypermarkets/departmental stores/pharmacies were visited and rice samples were collected). The product label information, claims declared on the pack and morphological features of the rice samples were examined and recorded using stereo-zoom microscope. Results: Fifteen rice samples of different categories including whole-grain rice (8), semi-polished rice (2) and polished white rice (5) were evaluated. Three samples had low-glycaemic index claims among whole-grain rice and 2 among polished white rice. The health claims were not supported with scientific evidence and were sometimes misleading as revealed by stereo-zoom microscopic examination. Conclusions: The authenticity of many of the health claims declared on the rice packs is questionable due to the lack of scientific evidence. The awareness about the quality of rice would be helpful for the consumer to make a wise choice about which cereal staple to purchase.

Oxidant/antioxidant status of Sudanese Type II diabetic patients with multiple complications Selma Mohammed Osman Mahmoud Yousif, Mohammed S M. Abdalla, Elmahdi M A. Elmahdi Journal of Diabetology 2019 10(2):69-75 Background: Diabetes-associated oxidative stress is induced by both increase in production of plasma-free radical concentrations and a significant reduction in antioxidant defence mechanisms, and it is associated with the pathophysiology of diabetes mellitus and its complications. Objectives: To evaluate the oxidant and antioxidant status in Type II diabetic patients with complications and diabetic patients without complications (DWC) compared to normal subjects and their association with diabetic complications. Materials and Methods: Plasma levels of malondialdehyde (MDA), antioxidant Vitamin C and antioxidant enzyme, superoxide dismutase (Cu-Zn SOD) activity were estimated in patients with diabetic nephropathy (DN), patients with diabetic neuropathy (DNe), diabetic patients with coronary artery disease (CAD), DWC, and controls matched for age, sex, body mass index and study region. Spectrophotometry and enzyme-linked immunosorbent assay techniques have been applied for the determination of MDA, Vitamin C and superoxide dismutase (SOD). Results: Comparing the level of Vitamin C and activity of SOD in all groups, it was observed that the lowest concentrations were found in CAD, DN and DNe groups, higher in DWC, and the highest in the control group. On the contrary, MDA levels (as an indicator of oxidative stress) were found to be increased in CAD, DN and DNe groups as compared to DWC and control groups. SOD and Vitamin C were found inversely correlated with glycosylated haemoglobin and MDA levels in all diabetic groups regardless of their complications. Multivariate model showed that all the variables independently associated with the diabetic complications. Conclusions: There is an imbalance between the oxidants and antioxidants in diabetic patients with complications and patients of DWC as compared to healthy groups.

Comparison of efficacy of add-on therapy of teneligliptin versus pioglitazone among type 2 diabetes mellitus patients ineptly controlled on dual therapy of metformin plus sulfonylurea Vanjari Nikhil Kumar, Sandeep Reddy Konyala, Siva Subrahmanyam Bandaru, Goverdhan Puchchakayala Journal of Diabetology 2019 10(2):76-82 Aim: The main aim of the study is to compare the efficacy of add-on therapy of teneligliptin (20 once daily) versus pioglitazone (15 mg once daily) among type 2 diabetes mellitus (T2DM) patients inadequately controlled on dual therapy of metformin (MF) plus sulfonylurea (SU). Materials and Methods: It is a prospective, observational, comparative study conducted in patients from the outpatient department of Sri Bhadrakali Hospital located at Warangal, Telangana state, India. The efficacy of pioglitazone and teneligliptin was assessed by measuring the change in the glycated haemoglobin (HbA1c), Fasting Plasma Glucose (FPG), Post Prandial Blood Glucose (PPBH) levels after 12 weeks of treatment. FPG, PPBG and HbA1c levels at baseline and 12 weeks. The primary endpoint was changed in HbA1c levels at 12 weeks as compared to the baseline levels in both groups. The secondary endpoints were changes in FPG, PPBG levels at 12 weeks as compared to baseline levels. Along with, serum cholesterol, triglycerides (TG), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels were measured both at baseline and after 12 weeks. Results: At study end, HbA1c levels were reduced from baseline by 0.7% (P = 0.0049) in the pioglitazone group and 1% (P = 0.0002) in the teneligliptin group. The mean changes in FPG levels from baseline to week 12 were −39.8 mg/dl (P ≤ 0.0001) in teneligliptin and −11.48 mg/dl (P = 0.00380) in pioglitazone group. The mean PPG levels from −47.8 mg/dl (P = 0.0003) in teneligliptin and −25.5 mg/dl (P = 0015) in pioglitazone group. After 12 weeks of study, the levels of TG, total cholesterol (TC), LDL −71.5 (P = 0.0973), −15 (P = 0.0501), 18.8 (P ≤ 0.0008) mg/dl and −31.38 (P ≤ 0.0001), −21 (P ≤ 0.0001), −11.68 (P = 0.0028) mg/dl in teneligliptin group and pioglitazone group, respectively. There was significant increase in HDL levels 5.3 (P ≤ 0.0001) mg/dl in teneligliptin group and 5.2 (P = 0.0001) mg/dl in pioglitazone group. Conclusion: Both teneligliptin 20 mg and Pioglitazone 15 mg provided additional HbA1c lowering to that achieved with MF and SU. Teneligliptin showed more effective reductions in HbA1c, FPG, PPBG, HDL and LDL levels. Pioglitazone showed significant changes in HbA1c, HDL, TC, triglyceride levels and significant changes in FPG, PPBG and LDL levels. Reduction in HbA1c and plasma lipids slows down the diabetes progression and decreases the risk of microvascular and macrovascular complications.

Study on glycaemic control by canagliflozin and its effect on insulin resistance and plasma ketone in type 2 diabetes mellitus patients JS Kumar, K Karthickeyan, Bansi R Patel, KI Haroon Meeran, G Karishma, Vishnu T Raveendran Journal of Diabetology 2019 10(2):83-86 Aims: The aim is to study the effect of glycaemic control by canagliflozin and its effect on insulin resistance (IR) and plasma ketone in type 2 diabetes mellitus (DM). Settings and Designs: The study was done at the Diabetes Clinic, General Medicine Department of the hospital. The study designed to be a prospective observational open-label study. Subjects and Methods: The study was conducted in 60 patients for 3 months. The patients were divided into two groups test and standard. Canagliflozin is given to test over- and above-standard treatment, and standard group is given to the standard treatment. Blood samples are collected at the beginning and at the end of the study. Parameters such as body weight, waist circumference, fasting blood glucose, haemoglobin A1c (HbA1c), plasma ketone and homeostatic model assessment-IR (HOMA-IR) were analysed. Statistical Analysis Used: Data obtained from the present studies were collected and analysed statistically using software IBM SPSS version 21. Results: Various parameters such as HbA1c and weight loss showed a significant difference before and after the study in both standard and test group, respectively. Whereas, other parameters such as HOMA-IR, waist circumference and fasting blood sugar levels showed significant difference only in the test group. Conclusions: Canagliflozin provided better glycaemic control in type 2 DM patients along with decreased IR and marked weight loss. Increased plasma ketone levels were noted during the course of the therapy to an extent which can be used up by the body as a fuel and not cause ketoacidosis.

Effect of sudden ban of pioglitazone on glycaemic control of type 2 diabetes mellitus patients in a tertiary care hospital in South India Sheetal Vasundara Mathai, Prabha M Adhikari, Sashidhar M Kotian Journal of Diabetology 2019 10(2):87-88

Anaesthesia & Intensive Care

Self-assessment Publication date: May 2019 Source: Anaesthesia & Intensive Care Medicine, Volume 20, Issue 5 Author(s): Viyayanand Nadella

Neurological and humoral control of blood pressure Publication date: May 2019 Source: Anaesthesia & Intensive Care Medicine, Volume 20, Issue 5 Author(s): Soumitra K. Ghosh, Jaideep J. Pandit Abstract There is a relationship between arterial blood pressure, cardiac output and vascular resistance described mathematically, that helps us to understand short-term control of blood pressure in terms of a hydraulic system. Arterial baroreceptors are specialized sensors which mediate a rapid response to sudden changes in pressure through interaction with the autonomic nervous system. This in turn influences heart rate, inotropic state and vascular tone, altering distribution of blood between arterial and venous systems, thus compensating for acute changes in total blood volume. Total blood volume is controlled predominantly by the kidney, with the renin–angiotensin–aldosterone system acting as both the 'sensor' of blood pressure/volume (via renin release in the juxtaglomerular apparatus) and the 'effector' of blood pressure/volume (via aldosterone secretion by the adrenal cortex). Overall control is shared; the baroreceptors being responsible for mediating short-term changes, and renal mechanisms determining the long-term control of blood pressure. These systems have to be adaptable in order to deal with physiological variation in the delivery of blood to tissues from rest to exercise, and with the large shifts in blood volume seen in acute haemorrhage. Pathophysiological changes in these systems lead to maladaptive responses, with systemic hypertension the most commonly seen.

Applied cardiovascular physiology Publication date: May 2019 Source: Anaesthesia & Intensive Care Medicine, Volume 20, Issue 5 Author(s): Carla Gould, Jon Hopper Abstract Maintaining an equilibrium between oxygen supply and demand is a principal function of the cardiovascular system. In times of altered metabolic demand mechanisms exist to maintain the balance between supply and demand. Exercise, haemorrhage and pregnancy all lead to changes in oxygen demand and subsequently modification of cardiac output. During isotonic exercise, metabolic demands of muscle are greatly increased. Sympathetic stimulation and inhibition of the parasympathetic system lead to increases in heart rate and venous return, increasing cardiac output. This allows a proportional increase in blood flow to the exercising muscle. Cardiac output increases throughout pregnancy. In the first and second trimesters this rise is mainly due to an increase in stroke volume, however during the later stages of pregnancy stroke volume reaches a plateau and further increase in cardiac output is mediated by a rising heart rate. In contrast, during haemorrhage, decreased venous return leads to a reduction in cardiac output, with a baroreceptor response due to the drop in arterial blood pressure. The tachycardia and vasoconstriction which follows are compensatory mechanisms in an attempt to preserve blood pressure. The Valsalva manoeuvre illustrates several aspects of reflex control of the cardiovascular system and allows non-invasive assessment and quantification of control mechanisms. Changes in stroke volume during the respiratory cycle can be used to predict fluid responsiveness and can be measured as pulse pressure variation or stroke volume variation.

Anaesthesia for carotid surgery Publication date: May 2019 Source: Anaesthesia & Intensive Care Medicine, Volume 20, Issue 5 Author(s): Michael Stallard, Indran Raju Abstract Carotid endarterectomy (CEA) is a surgical procedure to prevent strokes in patients with atheromatous disease at the carotid bifurcation. The effectiveness of CEA has been established in large clinical trials. Patients should have surgery performed within 2 weeks from the onset of symptoms. This time frame presents challenges to the anaesthetist and surgeon in terms of risk stratification and optimization of patients. Optimization includes blood pressure control and use of antiplatelet and lipid-lowering therapy. CEA can be carried out under general anaesthesia or regional anaesthesia with the advantages and disadvantages of both techniques discussed. Understanding surgical technique and the implications for anaesthesia is important, specifically the use of carotid shunting, eversion technique and patch angioplasty. Cerebral perfusion monitoring can be used during CEA to reduce neurological morbidity and mortality. The gold standard for monitoring remains an awake patient where sensory, motor and higher mental functions can be assessed continuously. Intraoperative and postoperative management may involve haemodynamic and neurological complications such as stroke, cerebral hyperperfusion syndrome, heart failure and myocardial infarction. Compromise to the airway can occur as a result of oedema or haematoma and the latter may require exploration in theatre.

Anaesthesia for the ruptured aortic aneurysm Publication date: May 2019 Source: Anaesthesia & Intensive Care Medicine, Volume 20, Issue 5 Author(s): Matthew Cheesman, Andrew Maund Abstract The perioperative management of ruptured abdominal aortic aneurysms (RAAA) remains a core anaesthetic competency. Changes such as service centralization, aneurysm screening and the developing role of emergency endovascular aneurysm repair (EVAR) are altering the demands upon anaesthetists. Whereas previously on-site general anaesthesia for resuscitative open aneurysm repair (OAR) was standard, now transfer, choice of surgical technique and options for anaesthetic management may need to be considered. We present the key components of emergency anaesthesia for both OAR and EVAR and describe clinical dilemmas arising at preoperative and intraoperative stages.

Anaesthesia for open abdominal aortic surgery Publication date: May 2019 Source: Anaesthesia & Intensive Care Medicine, Volume 20, Issue 5 Author(s): Alastair Duncan, Adam Pichel Abstract The prevalence of abdominal aortic aneurysm (AAA) and the number of patients undergoing aneurysm repair is increasing. The UK has worked tirelessly to reduce its operative mortality rates for elective open AAA repair with the introduction of a quality improvement programme. Reducing death from ruptured aortic aneurysm has been the focus of the national screening programme. Despite the increased prevalence of disease and intervention, the popularity of open repair has diminished since the advent of endovascular repair (EVAR). The short-term benefits of EVAR when compared to open repair are well described; however, the long-term survival benefits, freedom form re-intervention and cost effectiveness of EVAR are not proven. The choice of technique for emergency AAA repair is contentious, with the more traditional approach of open repair being rapidly overtaken by endovascular options. In this article we provide an overview of the evidence supporting the different treatment options, outline current approaches to risk stratification, describe the key physiological changes that occur during open repair and describe an overview of the approach to perioperative management.

Postoperative care and analgesia in vascular surgery Publication date: May 2019 Source: Anaesthesia & Intensive Care Medicine, Volume 20, Issue 5 Author(s): Shaun McMahon, Rachael L. Bird Abstract Patients undergoing major vascular surgery are high risk for myocardial infarction, renal failure, respiratory complications and death. Invasive procedures confer greater risk of complication, with patients undergoing open aortic surgery being at highest risk. Endovascular procedures are less invasive, yet not devoid of potentially serious complications. Reduction of myocardial oxygen demand is key: stabilizing cardiovascular parameters, maintaining normothermia, adequate volume resuscitation and effective analgesia. Continuation of preoperative risk-reduction strategies including aspirin, beta-blockers and statin therapies are critical, and should be continued in the postoperative period. Maintaining a high index of suspicion for procedure-specific complications is essential in order to reduce morbidity and mortality in these patients.

Anaesthesia for vascular surgery on the extremities Publication date: May 2019 Source: Anaesthesia & Intensive Care Medicine, Volume 20, Issue 5 Author(s): Richard J. Telford Abstract Peripheral arterial surgery is challenging, operations are frequently long and associated with insidious blood loss. Because of the high incidence of comorbidities these patients are a high-risk group with a high incidence of morbidity and mortality. They key to successful outcome is meticulous attention to detail by all those professions involved in their care.

Anaesthesia for endovascular aneurysm repair Publication date: May 2019 Source: Anaesthesia & Intensive Care Medicine, Volume 20, Issue 5 Author(s): John Barrett, Sian Jones Abstract A patient with an abdominal aortic aneurysm can have surgical management through either an open or endovascular approach. The use of an endovascular approach has benefits for the patient by being a less invasive approach with initially lower mortality and morbidity and lower lengths of hospital stay, although longer term outcomes match open techniques. The endovascular technique requires more specialist equipment, including stents and imaging equipment. In the UK they are usually performed in specialist hospitals with teams of interventional radiologists, vascular surgeons and anaesthetists working together. Patients presenting for endovascular repair of their abdominal aortic aneurysm can present the anaesthetist with range of complex comorbidities which require specific management and optimization pre-operatively. The intraoperative management of the patient can vary, depending on patient, surgical and anaesthetic factors, from local anaesthetic, regional techniques or general anaesthesia. The postoperative complications are generally minimal, but the patients require lifelong follow up, making the procedure more expensive than an open procedure.

Risk modification and preoperative optimization of vascular patients Publication date: May 2019 Source: Anaesthesia & Intensive Care Medicine, Volume 20, Issue 5 Author(s): Ben A. Goodman, Adam Pichel, Gerard R. Danjoux Abstract Major vascular surgery is associated with a high risk of morbidity and mortality. Targeted optimization of organ systems most likely to suffer morbidity should be made prior to elective surgery. Risk modification can reduce both perioperative and long-term complications. This article summarizes currently accepted best practice for risk modification and preoperative optimization prior to vascular surgery.

Acupuncture and Meridians

Complete Recovery following Electroacupuncture Therapy in Refractory Unilateral Sensorineural Hearing Loss Publication date: Available online 26 April 2019 Source: Journal of Acupuncture and Meridian Studies Author(s): Warangkana Arpornchayanon, Supanimit Teekachunhatean Abstract Role of electroacupucture (EA) in refractory unilateral sensorineural hearing loss (SNHL) remains unclear but might be promising for the Meniere's disease (MD). Two cases of unilateral SNHL who were unresponsive to conventional treatment of sudden SNHL showed complete recovery after receiving EA therapy. The first case was a 46-year-old female who received EA in the seventh month after the acute onset of sudden right hearing loss and tinnitus. She had mild-to-moderate degree of sensorineural hearing loss at high frequencies in the right ear with episodic vertigo. The second was a 55-year-old female who received EA in the sixth year after developing sudden SNHL in the right ear. Before the EA began, her pure tone average (PTA) of the affected ear was 45 dB and the phonetically balanced (PB)'s score was 88%. The regimen for both patients included 12 sessions of EA over four weeks at the main acupoints (SI 19, TE 21, TE 18, TE 17, and TE 3) on the affected ear and the bilateral adjuvant acupoints (LI 4, CV 6, CV 4, KI 3, and LIV 3). Both patients regained their normal hearing thresholds three weeks following the first EA. No adverse events were observed. Hence, EA may be a useful additional therapy in unilateral SNHL, even at the late phase when other treatments have failed because the possibility of MD cannot be excluded.

Canine and Feline Patients Referred Exclusively for Acupuncture and Herbs: A Two Year Retrospective Analysis Publication date: Available online 24 April 2019 Source: Journal of Acupuncture and Meridian Studies Author(s): Justin Shmalberg, Huisheng Xie, Mushtaq A. Memon Abstract Acupuncture and the administration of herbal supplements are increasingly utilized in veterinary practice, but no retrospective studies have examined patient characteristics and treatment interventions in a population of dogs and cats presenting exclusively for such therapies. This two-year retrospective analysis of 161 referrals to an integrative medicine service at an academic teaching hospital found that dogs were more frequently treated than cats (91.9% vs. 8.1%, respectively), and that small animal patients most frequently were presented for musculoskeletal (26.7%), neurologic (16.8%), oncologic (14.9%), and dermatologic (10.6%) conditions. Cats were older than treated dogs (12.7±3.7 vs. 9.5±4.3 years) and more likely to be treated for oncologic complaints (odds ratio = 5.6). Patients received acupuncture (95.4%), herbal supplements (76.4%), acupuncture with percutaneous electrical nerve stimulation (electroacupuncture, 26.1%), and/or cyanocobalamin injections in acupuncture points (aqua-acupuncture, 23.6%). Some differences were detected between treatment groups. This retrospective analysis provides a foundation for designing future prospective studies using acupuncture and herbs in dogs and cats.

Effects Of Scalp Acupuncture On Functional Deficits Induced By Early Sensorimotor Restriction Publication date: Available online 24 April 2019 Source: Journal of Acupuncture and Meridian Studies Author(s): Angela Kemel Zanella, Jessié Martins Gutierres, Felipe Stigger Abstract The aim of this study was to investigate the effects of scalp acupuncture and electrostimulation, combined or not, in a disuse model consisted of early sensorimotor restriction in rats. Male Wistar pups received sensorimotor restriction from the second postnatal day (P2) until P28. Animals were divided in 5 different groups (n=6): control (CT), sensorimotor restricted (SR), acupuncture (AC), electrostimulation (EL) and electro-acupuncture (AC+EL). Experimental animals received sham, acupuncture or electrical stimulation, combined or not, of two scalp regions for seven days (P29-P35). Previously to treatment period (P29) and after treatment (P36) animals were evaluated with the narrow suspended bar, horizontal ladder and stride length tests. SR animals had worse performance in the narrow suspended and horizontal ladder tasks compared to SR animals at P29 (p≤0.005). Significant improvements were observed in both tasks in AC, EL and EL+AC groups comparing P29 and P36 (p<0.001). Also, at P35 all treated animals performed significantly better motor tasks compared to SR group (p<0.05). There was no difference between treated groups. Finally, acupuncture and electrical stimulation, combined or not, have beneficial effect on motor performance following early developmental disuse.

Wet Cupping; Traditional Hijamah Technique versus Asian Cupping Technique in Chronic Low Back Pain Patients: Pilot Randomized Clinical Trial Publication date: Available online 24 April 2019 Source: Journal of Acupuncture and Meridian Studies Author(s): Sulaiman M. Al-Eidi, Ashry Gad Mohamed, Raid A. Abutalib, Abdullah M. AlBedah, Mohamed K.M. Khalil Abstract Background Low back pain is a common complaint worldwide. Wet cupping (AlHijamah) therapy, which is one of the common traditional therapies in Saudi Arabia, Asia, and some European countries, is usually used to relieve low back pain. However, the majority of high-quality wet cupping trials were conducted in Asia and Europe, where they use a different cupping technique compared to our local wet cupping technique in Saudi Arabia. Objectives To evaluate the feasibility of comparing the effect of the traditional Hijamah and the Asian wet cupping techniques in the management of Chronic Low Back Pain patients. Design Randomized clinical trial comparing traditional versus Asian wet cupping techniques in CLBP; Setting Outpatient clinics in two secondary care hospitals in Saudi Arabia. Patients Seventy eligible participants with CLBP for at least three months were randomly allocated to either Traditional cupping group (34) or the Asian cupping group (36). Intervention Participants were randomized to receive one session of wet cupping using either - Asian technique or Traditional Hijamah technique. Cupping was done at four sites of the bilateral Bladder Meridian (BL 23, BL24, and BL25). Outcome measures The Numeric Rating Scale (NRS), Present Pain Intensity (PPI), and Oswestry Disability Questionnaire (ODQ) scores were measured immediately after intervention, seven days, and 14 days after. Results In both groups, there was a significant decrease in NRS, PPI, and ODS, immediately after intervention and at seven days, and 14 days after intervention. However, there was no significant difference between the two groups across all the outcome measures up to 14 days after intervention. Conclusions The study did not show a superiority of one technique compared to the other. Longer follow-up periods and more than one cupping session may be needed to evaluate the difference, if any, between both techniques. Trial Registration NCT02012205.

Transcutaneous electrical stimulation of PC5 and PC6 acupoints modulates autonomic balance in heart transplant patients: a pilot study Publication date: Available online 23 April 2019 Source: Journal of Acupuncture and Meridian Studies Author(s): Beatriz Robert Moreira, Alice Pereira Duque, Carole Sant'Ana Massolar, Rodrigo de Lima Pimentel, Mauro Felippe Felix Mediano, Tereza Cristina Fellipe Guimarães, Luiz Fernando Rodrigues Junior Abstract The increased resting heart rate (HR) in heart transplant patients is associated with enhanced metabolic demand, the potential for fatigue, and lower quality of life. In the present study, we hypothesized that transcutaneous electrical acupoint stimulation (TEAS) could modulate autonomic balance and reduce resting HR in these patients. A single-arm clinical trial was conducted with patients aged > 18 years, at ambulatorial accompaniment after heart transplantation, were submitted to a single TEAS (40 minutes at PC5 and PC6 acupoints). The arterial blood pressure and RR interval were recorded from 20 minutes before to 20 minutes after TEAS. The RR intervals were used to calculate heart rate variability (HRV) and sympathovagal index. Linear mixed models were used for comparing variables before, during and after TEAS. The significance level was set as P < 0.05. TEAS acutely improved HRV in transplant patients and enhanced the sympathovagal index during its application. Significant increases in systolic, diastolic blood pressure and mean arterial pressure, were observed at recovery, such as a slight, but significant, decrease in heart rate. In conclusion, TEAS at PC5 and PC6 acutely modulates HRV and hemodynamics in transplant patients.

Concurrent Effects of Dry Needling and Electrical Stimulation in the Management of Upper Extremity Hemiparesis Publication date: Available online 23 April 2019 Source: Journal of Acupuncture and Meridian Studies Author(s): Maryam Selk Ghaffari, Ardalan shariat, Roshanak Honarpishe, Azadeh Hakakzadeh, Joshua A. Cleland, Sepehr Haghighi, Tohid Seif-Barghi Abstract Stroke is one of leading causes of disability in western countries. A variety of rehabilitation programs for the treatment of patients post stroke have been proposed. We describe the outcomes of a 49-year-old female patient with 5-year history of right upper extremity hemiparesis post stroke. Physical examination revealed a right wrist extensor strength grade of 1 according to the Medical Research Council Manual Muscle Testing (MMT) scale, stage 4 according to the Brunnstrom hand functional recovery and grade 1 in finger flexor and in wrist flexor according to the Modified Modified Ashworth Scale (MMAS) system of muscle spasticity. Magnetic Resonance Imaging taken immediately after the stroke was indicative of an abnormal signal in left paraventricle and lentiform nucleus. After receiving a single session of dry needling and electrical stimulation, the patient had significant improvement including a strength grade of 3 for the right wrist extensor muscles, stage 6 according to Brunnstrom hand functional recovery and a grade 0 in finger flexor and in wrist flexor according to MMAS system of muscle spasticity. This case report found that dry needling combined with electrical stimulation may be an effective in hand function recovery, wrist extensor muscles strength and decreased wrist and finger spasticity.

Accuracy and Precision in Acupuncture Point Location: A Critical Systematic Review Publication date: April 2019 Source: Journal of Acupuncture and Meridian Studies, Volume 12, Issue 2 Author(s): Debra R. Godson, Jonathan L. Wardle Abstract A number of studies have examined the accuracy and precision of acupuncture point location across various point location methods. Accuracy of point location is essential for safe, efficacious and reliable treatments and valid reproducible research outcomes. This review aims to identify, summarize, compare and critically appraise available empirical studies relating to the accuracy and precision of acupuncture point location. A comprehensive search of five electronic databases, World Journal of Traditional Chinese Medicine and Google scholar was performed for studies investigating accuracy and precision in acupuncture point location. 771 studies were screened of which 14 studies were identified, including 9 studies that investigated the localization of acupoints and 5 studies that examined the cun measurement system. Considerable variation in localization of acupoints was reported among qualified medical acupuncturists. Variation in point location among qualified non-medical acupuncturists is unknown due to lack of any identified study. The directional method was found to be significantly inaccurate and imprecise in all studies that evaluated the method. Suitability of other methods for clinical and research purposes and influencing factors such as education, training and experience were identified as topics for future studies.

Acupuncture for the Treatment of Cardiovascular Diseases: A Systematic Review Publication date: April 2019 Source: Journal of Acupuncture and Meridian Studies, Volume 12, Issue 2 Author(s): Rodrigo de Lima Pimentel, Alice P. Duque, Beatriz R. Moreira, Luiz F. Rodrigues Abstract Acupuncture, for the westerns countries, is an innovative and low-cost therapy for treatment and prevention of cardiovascular diseases (CVDs). However, most of its effects and mechanisms are poorly understood. Thus, the objective of this work was to systematically review the literature regarding the clinical effects of acupuncture for the treatment and prevention of CVDs. A search for papers published in English or Portuguese in the past 20 years was conducted at PubMed, SciELO, and PEDro databases. Clinical trials conducted on the effects of acupuncture were included in this review. Two reviewers extracted the data independently from the remaining 17 articles after screening. The most used acupoint was PC6 (10 studies, 64.7%), followed by ST36 (6 studies, 35.3%) and auricular acupoints (4 studies, 23.5%). Among the clinical applications, hypertension was the most studied CVD, with acupuncture being the most reported method among the studies (70.6%). Only three articles reported no benefit in the treatment of CVDs for the methodology used. We conclude that although several studies indicated an improvement in the response of the cardiovascular system in CVDs by acupuncture, electroacupuncture, or electrostimulation treatment, the heterogeneity of the studies does not allow a standardization of its application for each specific disease, making further studies necessary for its use to become a reality.

Editorial Board Publication date: April 2019 Source: Journal of Acupuncture and Meridian Studies, Volume 12, Issue 2 Author(s):

The Effect of Manual Acupressure (Point BL32) on Pain Associated with Intramuscular Injections of Magnesium Sulfate Publication date: April 2019 Source: Journal of Acupuncture and Meridian Studies, Volume 12, Issue 2 Author(s): Seyed S. Najafi, Setareh Nazaribin, Marzieh Momennasab, Amin Kordi Yoosefinejad Abstract The aim of this study was determining the effect of acupressure on the severity of pain associated with intramuscular injections of magnesium sulfate administered by the Z-track technique in patients with eclampsia and preeclampsia. Forty-eight patients participated in this single-group clinical trial, which was conducted in three stages. For each patient, three intramuscular injections were administered by the Z-track technique. The first injection was administered by the conventional method. The second injection at a sham control point and the third injection using acupressure (BL32) were administered. Pain severity was measured on a visual analogue scale. The mean pain intensity was 7.22 in the first, 4.75 in the second and 1.94 in the third injections (p < 0.001). The results of the study showed that acupressure at the BL32 point before intramuscular injection of magnesium sulfate significantly reduced the injection-related pain.

Journal of Dr. NTR University of Health Sciences

Study of outcome of management of MDR-TB cases under programmatic condition in India Ajay Agarwalla, Somnath Bhattacharya, Atin Dey, Saurav Kar, Arunabha Datta Chaudhuri Journal of Dr. NTR University of Health Sciences 2019 8(1):1-4 Background: Multi-drug resistant tuberculosis is a grave challenge for tuberculosis control program in India. These patients are treated with standardized 2nd line antitubercular drugs for a period of at least 24 months and are followed up by serial sputum cultures under RNTCP. Aims: This study aims to analyze various outcomes of treatment of MDR-TB patients under DOTS-Plus program and impact of different parameters over the outcome. Materials and Methods: In this retrospective study treatment outcome all the MDR-TB patients who have initiated treatment from concerned DRTB centre over a period of six months, have been taken for analysis, after 30–36 months of starting the therapy. Outcomes are categorized as cured, treatment completed, treatment default, treatment failure, and death as per program guideline. Outcome of different group of patients are compared also. Results: Out of total 71 patients 54 resides in rural area and 52 have low BMI (<18.5). Total 27 (38%) patients are successfully treated. Treatment failure observed in 11 (16%). 20 (28%) patients defaulted. Rural patients have lower success rate (33%) and high default rate (30%). Low BMI patients have poor success (29%). Conclusion: The present study finds a low success rate in comparison to WHO reports from India. Default rate is also found to be high. Majority of patients are from rural area and they have higher default rate compared to urban patients. Patients with low BMI have lower success rate and these patients constitutes about three-fourth of total patients. But as the total number of patients is very small, the significance of this observation cannot be ascertained.

Fetal transcerebellar diameter to abdominal circumference ratio (TCD/AC) and to femur length ratio (TCD/FL) in the assessment of normal fetal growth Karumanchi Ashok Hussain, Silpa Kadiyala, Amancharla Yadagiri Lakshmi, Manchala Hindumathi Journal of Dr. NTR University of Health Sciences 2019 8(1):5-10 Context: Intrauterine growth retardation (IUGR) is a major risk factor for perinatal mortality and morbidity, and its early detection is useful in deciding frequency of antenatal surveillance, optimal delivery timing, and early neonatal management to avoid perinatal mortality and morbidity. Most of the parameters for detection of IUGR are gestational age dependent. Transcerebellar diameter to abdominal circumference ratio (TCD/AC) is a gestational age independent parameter. IUGR due to uteroplacental insufficiency can present as isolated femur length reduction. So, transcerebellar diameter to femur length ratio (TCD/FL) can be useful in early detection of IUGR. Aims: To evaluate the accuracy of TCD/AC and utility of TCD/FL in normal pregnancy at varying periods of gestation and to derive a cut-off value for assessment of fetal growth. Materials and Methods: In this prospective study, 200 patients with cumulative ultrasound age (CUA) between 14-40 weeks. Routine ultrasound parameters and transcerebellar diameter were measured. TCD/AC and TCD/FL was calculated in all patients and for individual subgroups formed according to CUA. Statistical Analysis: Mean and standard deviation, 3rd, 50th and 97th percentile for TCD/AC and TCD/FL was determined for all patients to determine age specific cut off values. Relationship between continuous variables is studied using correlation and simple regression. Results: In our study, TCD with AC and FL show strong correlation throughout pregnancy. TCD/AC dispersed normally with mean value of 14.013 and SD of 0.738 and cut off value is 15.49. TCD/FL is dispersed normally throughout pregnancy with mean value 64.592 and SD of 3.998. TCD/AC, TCD/FL in subgroups also shows similar mean and SD as compared to entire study population. Conclusion: A cut off value of mean +/- SD (15.49), (72.588) for TCD/AC and TCD/FL could be used as a growth parameter for detection and determine the severity of IUGR.

Application of the Milan system of reporting salivary cytopathology – A retrospective cytohistological correlation study Ramya Katta, Devi Padmavathi Chaganti Journal of Dr. NTR University of Health Sciences 2019 8(1):11-17 Context: Fine needle aspiration cytology for salivary gland lesions has shown to be adequately sensitive and specific for diagnosing and treating salivary gland pathologies. The Milan System for Reporting Salivary Gland Cytopathology was developed and introduced to provide enhanced communication and improved overall care. Aims: The present study was taken up to assess the accuracy (sensitivity, specificity, positive and negative predictive values) and risk of malignancy of various diagnostic categories when the Milan system is applied and particular emphasis has been laid on cases that showed varied cytohistopathological correlation to highlight the analytical intricacies. Settings and Design: The present study is a two-year retrospective descriptive study conducted in a tertiary care hospital, Vijayawada. Methods and Material: Fine needle aspiration smears, relevant clinical details, histopathological slides and final reports were retrieved from the Departmental archives. The FNA results of the present study were re-categorized according to the Milan system and number of false positives, false negatives, true positives and true negatives were assessed in comparison with the final histopathological diagnosis and thus the accuracy and risk of malignancy of each diagnostic category were calculated. Results: The overall cytological diagnostic accuracy for differentiating malignant from benign tumors in the present study is 90%, with a sensitivity of 73.34%, specificity of 95.56%, positive and negative predictive values of 84.62% and 91.49% respectively.In the present study the highest risk of malignancy was seen in Atypia of undetermined significance (category III-100%) according to the Milan system. Conclusions: Use of The Milan System of Reporting salivary gland Cytopathology can increase the overall effectiveness and communication with clinicians and between institutions thus improving the overall patient care.

Serum and gingival crevicular fluid macrophage inflammatory protein-1β (MIP-1β): Their relationship in periodontal health, disease, and after treatment with nonsurgical therapy Ravindra R Nagireddy, Bindu Sighinam, Deepa Anumla, Sravani R Cheppali, Lakshmi S Shellysistla, Madhu B Dandu Subramanyam Journal of Dr. NTR University of Health Sciences 2019 8(1):18-23 Objectives: Earlier studies have revealed high macrophage inflammatory protein-1β (MIP-1β) levels in the gingival crevicular fluid (GCF) and the serum of patients with chronic periodontitis. However, reports correlating effect of non surgical theraphy on levels of GCF and serum MIP-1βlevels are inadequate. Therefore, the present study estimates the GCF and serum MIP-1β levels in periodontal health, disease and after periodontal treatment with non surgical theraphy. Materials and Methods: Periodontal examination and collection of GCF and serum was performed for 60 subjects categorized into four groups with 20 subjects in each group: Group I (healthy); group II (gingivitis), group III (chronic periodontitis). Twelve weeks after scaling and root planing, the GCF and serum were collected from 20 patients of group III, who were considered as group IV. MIP-1β levels were estimated using the enzyme-linked immunosorbent assay. Results: MIP-1β was detected in all samples. However, the levels reduced significantly in group IV (P < 0.05). Mean MIP-1β levels in GCF and serum were the highest in group III (1.404 ng/μL,1.712 ng/μl) and the lowest in group I (0.342 ng/μl,0.465 ng/μl), and those in groups II and IV appeared between those of groups I and III. Conclusions: The GCF and serum MIP-1β levelsincreased proportionally with the progression of periodontal disease (PD) and decreased after treatment. Because MIP-1β levels in the GCF and serum correlated positively with clinical parameters, MIP-1βmay be considered a “novel biomarker” in PD progression. However, controlled longitudinal studies are required to confirm this possibility.

Comparative assessment of effectiveness of Biomin, NovaMin, herbal, and potassium nitrate desensitizing agents in the treatment of hypersensitive teeth: A clinical study Guntakala Vikram Reddy, Jayaprada Reddy Surakanti, Harikumar Vemisetty, Suryasowjanya Doranala, Jayasree Reddy Hanumanpally, Suryakanth Malgikar Journal of Dr. NTR University of Health Sciences 2019 8(1):24-28 Aim and Objectives: To compare the efficacy of four commercially available toothpastes in the treatment of dentinal hypersensitivity (DH). Materials and Methods: In a single-centered clinical trial, a total of 160 subjects were divided equally into four groups: group 1 – a toothpaste containing 5% fluoro calcium sodium phosphosilicate with fused silica (Biomin); group 2 – a toothpaste containing 5% CSPS (NovaMin); group 3 – herbal formulation; and group 4 – a toothpaste containing 5% potassium nitrate. The patient's DH scores for tactile, evaporative stimuli were recorded on a visual analog scale at baseline, 2 weeks, and at the end of 4 weeks. Results: All the four desensitizing toothpastes containing different active agents were effective in relieving DH. However, the Biomin group showed a better clinical response at the end of 4 weeks when compared with others. Conclusion: The Biomin group showed significantly better results compared with either NovaMin, herbal, and potassium nitrate toothpastes in the treatment of dental hypersensitivity symptoms.

Prevalence of dental caries and dental fluorosis among 6-12 years old school children in relation to fluoride concentration in an endemic fluoride belt of Mahabubnagar district, Telangana state, India Srikanth Reddy Kola, Manoj Kumar Mallela, Ravindar Puppala, Balaji Kethenaeni, P Tharasingh, Venumbaka Sivakalyan Reddy Journal of Dr. NTR University of Health Sciences 2019 8(1):29-36 Aim: The aim of the study is to evaluate the prevalence of dental caries and dental fluorosis among the school going children in Mahabubnagar district, and also to assess F- levels in drinking water from different areas of Mahabubnagar district. Materials and Methods: The study was carried out in 2,000 children of age group 6–12 years. The dental caries status was assessed by Decayed/missed filled tooth (DMFT)/deft index using WHO criteria 1997 and dental fluorosis status using Modified Dean's fluorosis index. Alizarin visual method was used to estimate F levels in water. Statistical Analysis: All data entered to an SPSS (18) program (IBM Corporation, Chicago, USA); both descriptive and analytic approaches were used in the data analysis. The correlation of deft with different F- levels using ANOVA test. The P < 0.005 was considered statistically significant. Results: The prevalence of dental caries in primary teeth and permanent dentition was 64.2% and 26.6%, respectively. Indicating that dental caries was more among 7–8 years old children and less in 11–12 years old children (P > 0.005). Dental fluorosis in primary dentition was 15% and 70.3% in the permanent dentition; it was more in 9–10-year-old children and less in 6-year-old children. Conclusion: The dental caries and dental fluorosis were more in Northern, Eastern region of Mahabubnagar district, whereas dental caries and dental fluorosis were less in local villages of Mahabubnagar district. The F- content in Northern, Eastern zone of Mahabubnagar district was about 2 mg/l, whereas in local villages of Mahabubnagar is 1.2 mg/l.

Efficacy of autologous platelet-rich fibrin in osseous regeneration after mandibular third molar surgery: A comparative study K Surekha, Sudhakar Gudipalli, Praveen Peramulla, T Prathima, Y Narendra Kumar, Anil Budumuru Journal of Dr. NTR University of Health Sciences 2019 8(1):37-41 Aims and Objectives: To evaluate the efficacy of soft tissue healing and bone regeneration in mandibular third molar extraction sockets after placement of platelet-rich fibrin (PRF). Patients and Methods: A split-mouth study was carried out in 15 patients requiring extraction of bilateral impacted mandibular third molars. Patients were divided into group I (test group) and II (control group) of 15 sites in each. Results were compared within the parameters of postoperative pain, facial swelling, soft tissue healing and bone density. Radiological assessment of the extraction site was done. Results: This study clearly indicates a definite improvement in the wound healing, decrease in postoperative edema, wound dehiscence, and increase in the bone density, which signifies and highlights the use of PRF certainly as a valid method inducing hard tissue regeneration. Conclusion: The procedure of PRF preparation is simple, cost-effective, and has demonstrated good results.

Dental students persepctive towards a learning environment and in determining the learning barriers P Gayathri, L Gayathri, D Sravya Sai, Vikram Simha Bommireddy, Y Suresh Chand Journal of Dr. NTR University of Health Sciences 2019 8(1):42-47 Background: Dental education is relatively complex, demanding and a unique pedagogical procedure. The purpose of this study was to determine dental student's perception of the learning environment and to determine the learning barriers among dental students in a private college located in Guntur district, Andhra Pradesh. Materials and Methods: The source of the data includes 306 dental under-graduate students, from academic years 1-4. There are divided into two groups i.e. 159 pre-clinical students and 147 clinical students. They were posed with a validated structured questionnaire, which includes 28 closed ended questions along with questions on 3 different domains i.e. administrative, academic and environmental learning barriers. Results: The overall response rate is 100%. At the administrative level, maximum number of students identified that there was poor academic guidance for the students during courses registration given and there are inadequate extra-curricular activities for the students such as conferences, workshops and seminars. At academic level, 20.6% dental students proposed that questions in the exam are depending on memorising rather than understanding and analysing. 12.2% of the clinical students stated that there was lack of appropriate teaching strategies of the lecturers which are acting as learning barriers. As environmental factors, most of the students agree that inadequate number of computers and the unavailability of internet connection, unavailability of entertainment facilities that motivate the learning process and that the laboratories aren't equipped in terms of space and equipment's for training which would affect the learning process. Conclusion: This study has emphasized on the factors which requires improvement with respect to student's perspective. These learning barriers are to be noted by the educational institutions and the required modifications are done in the infrastructure as well as in the curriculum proposed to the students. Better dental education will instill positive reinforcement, social well-being and a better professional and personality development in the dental students which would guide them into their future.

Reconstruction of lost ear lobule Subodh Kumar Arige, Ramesh Pokkula, Avula Krishnaveni Journal of Dr. NTR University of Health Sciences 2019 8(1):48-51 Introduction: An absent ear lobule may be congenital or the result of trauma, infection, etc. Many procedures have been described for reconstruction. Aim: To present our experience with the Zenteno Alanis and the Gavello techniques. Materials and Methods: The lobule was reconstructed in four patients. Reconstruction of the lobule in the first patient was done by Zenteno Alanis technique and in the next three patients, it was done by Gavello's technique. Results: Results were satisfactory with both techniques. Division and inset were needed in Zenteno Alanis technique to correct the bunched skin behind the lobule at the base of the flap. The scar was inferior and visible. In Gavello's technique, the surgery was single-staged and the scar was retroauricular. Conclusions: Zenteno Alanis technique needed “division and inset” and the scar was visible. Gavello's single-staged reconstruction resulted in a scar, which could be concealed.

Prenatal diagnosis of intrauterine fetal goiter a rare case report Joji Reddy Onteddoo, J Abdul Gafoor, I Pratyusha, N Bhavana Journal of Dr. NTR University of Health Sciences 2019 8(1):52-54 The incidence of fetal goiters is rare and can have poor neonatal outcomes due to tracheal and esophageal obstruction. This makes prenatal diagnosis and treatment pertinent. We report a case of a 25-year-old fifth gravida diagnosed with a large solid homogenous bilobed hypervascular mass noted on the anterior of the fetal neck, causing hyperextension of the cervical spine. A Fetal MRI was performed which revealed intermediate to hyper intensity on T2 weighted image, which were consistent with fetal goiter. The fetus was delivered at 38 weeks of gestation, and the intrapartum and postpartum period was uneventful. Postnatal TSH FT3 and FT4 were done which were consistent with hypothyroidism. With appropriate treatment, the size of the thyroid gland was observed to decrease. The neonate was found to be doing well postnatally.

Neurosurgery

Spinal cord stimulation in pregnant patients: Current perspectives of indications, complications, and results in pain control: A systematic review Bruno Camporeze, Renata Simm, Marcos Vinícius Calfat Maldaun, Paulo Henrique Pires de Aguiar Asian Journal of Neurosurgery 2019 14(2):343-355 Spinal cord stimulation (SCS) has been described as a valuable neuromodulator procedure in the management of chronic medically untreated neuropathic pain. Although the use of this technique has been published in many papers, a question still remains regarding its applicability in pregnant patients. The goal of this paper is to discuss the risks, complications, and results as well as the prognosis of SCS in pregnant patients. We performed a systematic review from 1967 to 2018 using the databases MEDLINE, LILACS, SciELO, PubMed, and BIREME, utilizing language as selection criteria. Eighteen studies that met our criteria were found and tabulated. SCS is a reversible and adjustable surgical procedure, which results in patients that demonstrated a significant effect in the reduction of pain intensity in pregnant patients. The etiologies most frequent were complex regional pain and failed back pain syndromes, which together represented 94% of analyzed cases. The technical complications most frequent were lead migration (3%, n = 1). Regarding the risks, the authors did not show significative factors among the categorical variables that can suggest a teratogenicity, while the maternal risks have been associated to the consequences of technical complications due to, among other factors, improvement of abdominal pressure during pregnancy and delivery. Finally, although there are not significative cohorts of pregnant patients, the procedure is still an effective surgical approach of neuropathic pain associated to lower rates of complications and significative improvement in the quality of life of patients during pregnancy.

Diffuse low-grade glioma – Changing concepts in diagnosis and management: A review Rashid Jooma, Muhammad Waqas, Inamullah Khan Asian Journal of Neurosurgery 2019 14(2):356-363 Though diffuse low-grade gliomas (dLGGs) represent only 15% of gliomas, they have been receiving increasing attention in the past decade. Significant advances in knowledge of the natural history and clinical diversity have been documented, and an improved pathological classification of gliomas that integrates histological features with molecular markers has been issued by the WHO. Advances in the radiological assessment of dLGG, particularly new magnetic resonance imaging scanning sequences, allow improved diagnostic and prognostic information. The management paradigms are evolving from “wait and watch” of the past to more active interventional therapy to obviate the risk of malignant transformation. New surgical technologies allow more aggressive surgical resections with a reduction of morbidity. Many reports suggest the association of gross total resection with longer overall survival and progression-free survival in addition to better seizure control. The literature also shows the use of chemotherapeutics and radiation therapy as important adjuncts to surgery. The goals of management have has been increasing survival with increasing stress on quality of life. Our review highlights the recent advances in the molecular diagnosis and management of dLGG with trends toward multidisciplinary and multimodality management of dLGG with an aim to surgically resect the primary disease, followed by chemoradiation in cases of progressive or recurrent disease.

Simulation training methods in neurological surgery Louise Makarem Oliveira, Eberval Gadelha Figueiredo Asian Journal of Neurosurgery 2019 14(2):364-370 Simulation training plays a paramount role in medicine, especially when it comes to mastering surgical skills. By simulating, students gain not only confidence, but expertise, learning to apply theory in a safe environment. As the technological arsenal improved, virtual reality and physical simulators have developed and are now an important part of the Neurosurgery training curriculum. Based on deliberate practice in a controlled space, simulation allows psychomotor skills augment without putting neither patients nor students at risk. When compared to the master-apprentice ongoing model of teaching, simutation becomes even more appealing as it is time-efficient, shortening the learning curve and ultimately leading to error reduction, which is reflected by diminished health care costs in the long run. In this chapter we will discuss the current state of neurosurgery simulation, highlight the potential benefits of this approach, assessing specific training methods and making considerations towards the future of neurosurgical simulation.

The role of decompressive craniectomy in traumatic brain injury: A systematic review and meta-analysis Nida Fatima, Ghaya Al Rumaihi, Ashfaq Shuaib, Maher Saqqur Asian Journal of Neurosurgery 2019 14(2):371-381 The objective is to evaluate the efficacy of early decompressive craniectomy (DC) versus standard medical management ± late DC in improving clinical outcome in patients with traumatic brain injury (TBI). Electronic databases and gray literature (unpublished articles) were searched under different MeSH terms from 1990 to present. Randomized control trials, case–control studies, and prospective cohort studies on DC in moderate and severe TBI. Clinical outcome measures included Glasgow Coma Outcome Scale (GCOS) and extended GCOS, and mortality. Data were extracted to Review Manager software. A total of 45 articles and abstracts that met the inclusion criteria were retrieved and analyzed. Ultimately, seven studies were included in our meta-analysis, which revealed that patients who had early DC had no statistically significant likelihood of having a favorable outcome at 6 months than those who had a standard medical care alone or with late DC (OR of favorable clinical outcome at 6 months: 1.00; 95% confidence interval (CI): 0.75–1.34; P = 0.99). The relative risk (RR) of mortality in early DC versus the standard medical care ± late DC at discharge or 6 months is 0.62; 95% CI: 0.40–0.94; P = 0.03. Subgroup analysis based on RR of mortality shows that the rate of mortality is reduced significantly in the early DC group as compared to the late DC. RR of Mortality is 0.43; 95% CI: 0.26–0.71; P = 0.0009. However, good clinical outcome is the same. Early DC saves lives in patients with TBI. However, further clinical trials are required to prove if early DC improve clinical outcome and to define the best early time frame in performing early DC in TBI population.

Hypertonic solutions in traumatic brain injury: A systematic review and meta-analysis Nida Fatima, Ali Ayyad, Ashfaq Shuaib, Maher Saqqur Asian Journal of Neurosurgery 2019 14(2):382-391 This study aims to evaluate the efficacy of hypertonic saline versus crystalloids (normal Saline/lactated Ringers) in improving clinical outcome in patients with traumatic brain injury (TBI). Electronic databases and grey literature (unpublished articles) were searched under different MeSH terms from 1990 to present. Randomized control trials, case–control studies and prospective cohort studies on decompressive craniectomy in TBI (>18-year-old). Clinical outcome measures included Glasgow Coma Outcome Scale (GCOS), Extended GCOS, and mortality. Data were extracted to Review Manager Software. A total of 115 articles that met the inclusion criteria were retrieved and analyzed. Ultimately, five studies were included in our meta-analysis, which revealed that patients with TBI who had hypertonic saline had no statistically significant likelihood of having a good outcome at discharge or 6 months than those who had crystalloid (odds ratio [OR]: 0.01; 95% confidence interval (CI): 0.03–0.05; P = 0.65). The relative risk (RR) of mortality in hypertonic saline versus the crystalloid at discharge or 6-month is RR: 0.80; 95% CI: 0.64–0.99; P = 0.04. The subgroup analysis showed that the group who had hypertonic solution significantly decreases the number of interventions versus the crystalloid group OR: 0.53; 95% CI: 0.48–0.59; P < 0.00001 and also reduces the length of intensive care unit stay (OR: 0.46; 95% CI: 0.21–1.01; P = 0.05). Hypertonic saline decreases the financial burden, but neither impacts the clinical outcome nor reduces the mortality. However, further clinical trials are required to prove if hypertonic saline has any role in improving the clinical and neurological status of patients with TBI versus the normal saline/lactated Ringers.

Impact of comorbidities on outcome following revision of recurrent single-level lumbar disc prolapse between revision microdiscectomy and posterior lumbar interbody fusion: A single-institutional analysis Chiazor U Onyia, Sajesh K Menon Asian Journal of Neurosurgery 2019 14(2):392-398 Objectives: Reports exist in the literature on the relationship between comorbid conditions and recurrence of lumbar disc herniation. Meanwhile, documented evidence abound on microdiscectomy and posterior lumbar interbody fusion (PLIF) as techniques of managing recurrent disc prolapse. Some surgeons would choose to perform PLIF instead of microdiscectomy for a first time re-herniation, because of the possibility of higher chances of further recurrence as well as increased likelihood of spinal instability following treatment with microdiscectomy. In this study, the authors sought to determine whether PLIF is better than microdiscectomy for first-time recurrent single-level lumbar disc prolapse and to compare the impact of comorbidities on outcome following revision. Patients and Methods: This was retrospective review of surgical treatment of patients with recurrent single-level disc prolapse with either microdiscectomy or PLIF at a tertiary health institution in India. Results: A total of 26 patients were evaluated. There was no statistically significant correlation between the presence of comorbidity and outcome in terms of improvement of pain (P > 0.05 at 95% degree of confidence; Spearman's ρ =0.239). Patients who had PLIF were neither more nor less likely to have a better outcome compared to those who had microdiscectomy, though this finding was not statistically significant (odds ratio = 0.263; P = 0.284). Conclusion: There was no significant relationship between the presence of comorbidity and outcome following revision. Microdiscectomy did not prove to be a better option than PLIF for surgical management of recurrent single-level disc prolapse. A quality randomized controlled study would help to validate these findings.

Endoscopic third ventriculostomy in children with failed ventriculoperitoneal shunt Bijan Heshmati, Zohreh Habibi, Mehdi Golpayegani, Farhad Salari, Mousarreza Anbarlouei, Farideh Nejat Asian Journal of Neurosurgery 2019 14(2):399-402 Context: Endoscopic third ventriculostomy (ETV) is an accepted procedure for the treatment of obstructive hydrocephalus. The role of endoscopic treatment in the management of shunt malfunction was not extensively evaluated. The aim of this study is to evaluate the success rate of ETV in pediatric patients formerly treated by ventriculoperitoneal (V-P) shunt implantation. Materials and Methods: Thirty-three patients with their first shunt failure and obstructive hydrocephalus in brain imaging between 2008 and 2014 were enrolled in this study. Results: The most common causes of hydrocephalus in these patients were aqueductal stenosis and myelomeningocele with or without associated shunt infection. Of these 33 cases, 20 ETV procedures were successful, and 13 cases needed shunt revision after ETV failure. There was no serious complication during ETV procedures. The follow-up period of patients with successful ETV was 6–50 months (mean 18 months). The time interval between ETV and new shunting subsequent to ETV failure was 24.4 days (10–95). Conclusions: ETV can be considered as an alternative treatment paradigm in patients with previous shunt or new shunt failure with an acceptable success rate of 6o%, although long-term follow-up is needed for these patients.

Predictive factors for seizures accompanying intracranial meningiomas Moamen Mohamed Morsy, Waleed Fawzy El-Saadany, Wael Mohamed Moussa, Ahmed Elsayed Sultan Asian Journal of Neurosurgery 2019 14(2):403-409 Objective: Seizures represent a common manifestation of intracranial meningiomas. Their predictive factors before and after excision merit studying. Materials and Methods: Patients having intracranial meningioma were prospectively studied. There were two groups; Group “A” with seizures and Group “B” with no preoperative epilepsy. Results: This study included 40 patients. Their ages ranged from 40 to 60 years old, and female-to-male ratio was 2.3:1 in both groups. In Group A, partial seizures were the most common pattern (60%). Manifestations other than fits included headache in most patients (97.5%), symptoms of increased intracranial pressure were found in 50% in Group A and 20% in Group B patients, peritumoral edema was present in 14 (70%) patients of Group A, compared to 6 (25%) patients of Group “B.” There was a statistically significant relation between peritumoral edema and presentation with fits (P < 0.1). Complication after surgery included nonsurgical hematoma in three patients and contusion in 7 patients. Following surgery for Group “A”, 8 (40%) patients had good seizure control. While, in Group “B” 3 (15%), patients developed new-onset seizures. Good seizure control in 7 (53%) patients with frontal, frontotemporal tumors than in other locations. In addition, better control was obtained in left sided, small tumors, and no peritumoral edema. Postoperative complication was significantly associated with new-onset epilepsy and poor seizure control (P < 0.05). Neither tumor size nor location had a significant relation to either pre or postoperative epilepsy. Conclusion: Predictive factors for epilepsy accompanying intracranial meningioma included males, elderly patients and patients with small lesions, frontal and left-sided locations but were statistically insignificant predictors. Peritumoral edema and postoperative complications are the most significant predictors.

Compound elevated skull fracture presented as a new variety of fracture with inimitable entity: Single institution experience of 10 cases Ashok Kumar, Vivek Kumar Kankane, Gaurav Jaiswal, Pavan Kumar, Tarun Kumar Gupta Asian Journal of Neurosurgery 2019 14(2):410-414 Background: Compound elevated Skull fracture (CESF) is a rare variety of fracture with rare presentation in comparison to other type of skull fracture. The mechanical force being applied is tangential causing high impact over skull as comparison to structure underlying the cranium. Objective: Aims of this study are bring attentiveness and management to deal this rare type of fracture and its outcomes. Materials and Methods: In this study, we demonstrated 10 cases of CESF in adult patients from January 2014 to January 2018 in the Department of Neurosurgery at RNT Medical College and M. B. Hospital, Udaipur, Rajasthan, India. Recorded documents were prospectively studied for age of distribution, sex, mode of injury, mechanism of injury, clinical profile, radiological investigations, neurosurgical management, and outcome asses by Glasgow outcome scale. Results: Totally 10 patients had CESF. Six are males and four are females. Male to female ratio was 3:2. Their age range was 20–45 years. The most common mode of injury was Road traffic accident in 60%. Wound exploration, cleaning, debridement, and reduction of fracture segment was done in eight cases, frontal bone craniotomy with evacuation of pneumocephalus done one case, frontal bone craniotomy, and extradural hematoma evacuation was done in one case. The postoperative course was uneventful, and outcome was good (GOS 5) in 8 (80%) cases. Conclusion: In compound elevated fracture, early recognition and immediate surgical intervention should be done to avoid related morbidity and mortality. Any delay in surgery may lead to a high possibility of wound infection and poor outcome.

Outcome analysis of surgical clipping for incidental internal carotid posterior communicating and anterior choroidal artery aneurysms Ameen Abdul Mohammad, Yamada Yasuhiro, Liew Boon Seng, Niranjana Rajagopal, Kato Yoko Asian Journal of Neurosurgery 2019 14(2):415-421 Introduction: Surgical outcome and ischemic complications of Internal carotid Posterior Communicating (IC PC) and anterior choroidal aneurysms have been questionable due to frequent occlusion of the anterior choroid artery and also due to low incidence of true anterior choroid artery aneurysms. The present series describes the postoperative outcome after clipping of such aneurysms at a single centre. Methods: A retrospective analysis of 73 cases with IC PC and Anterior choroidal aneurysms performed at a Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Aichi, Japan from 2014 to 2018 have been studied and emphasis is made on the demography and ischemic complications. Results: A total of 73 patients with IC PC and anterior choroidal aneurysms were studied, out of which 57 patient had a true IC PC aneurysm, 14 patients had aneurysms involving the anterior choroidal artery and only 2 patients had aneurysms which involved both the IC PC and the anterior choroidal arteries. None of the patients had a permanent Anterior Choroidal Artery syndrome, whereas only 2 out of the 73 patients had postoperative complications in the form of transient hemiparesis. Conclusion: Ischemic complications following surgical clipping of IC PC and anterior choroidal aneurysms can be minimised by meticulous micro dissection to identify the anterior choroidal artery thus preserving the patency of the same.