Carcinoid tumors are rare, slow-growing neoplasms of neuroendocrine tissues from enterochromaffin or kulchitsky cells, which have the potential to metastasize. The mediators released from these tumors when bypass the hepatic metabolism, can lead to the possible development of carcinoid syndrome. This is a life-threatening complication, which can lead to profound hemodynamic instability, especially in a peri-operative period, when the patient is exposed to various types of noxious stimuli. Off late, use of octreotide, a synthetic analog of somatostatin, has significantly reduced the peri-operative morbidity and mortality. The current review discusses the various anesthetic challenges and considerations during peri-operative management of carcinoid tumors.

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Chondrosarcoma is a malignant tumor of bone showing cartilaginous differentiation. Fine needle aspiration cytology (FNAC) is found to be effective in the preoperative diagnosis of chondrosarcoma combined with radiological and clinical evaluation. Ribs is one of the most common skeleton sites for chondrosarcoma, the others being pelvis, proximal femur, proximal humerus and distal femur. We are presenting the case of a 40-year-old man who presented with a tumor in the anterior chest wall on the left side. On FNAC of the mass, a diagnosis of low-grade chondrosarcoma was made which was later confirmed on histopathology.

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Introduction: The spectrum of anaemia is modified in many parts of world, due to prevalence haemoglobinopathies. The common haemoglobinopathies includes HbS, HbC, D (Punjab) and E. In Assam with its population consisting of diverse ethnic groups, is a rich reservoir of abnormal haemoglobin and thalassaemia. The incidence of HbE from various population survey of Assam showed that 20% among Indig Assamese, 57.4% among Ahoms and as high as 80% among Bodo-Kacharis. Iron therapy is hazardous in haemoglobinopathies due to risk of tissue iron toxicity, so needs evaluations of iron status before iron therapy. The size of the stored iron in the body is accurately indicated by serum ferritin estimation, which is single most sensitive and non-invasive method for iron status evaluation. Keeping all in minds the aim of the our study is to study the serum ferritin level of patients with HbE attending AMCH, Dibrugarh. Materials and Methods: This study was conducted in the department of medicine, AMCH for 1-year. 80 HbE patients of various religions and tribes were selected for study. Patients with HbE having malignancy, end stage renal disease, arthritis, chronic liver disease, and sepsis were excluded from the present study by careful history taking and laboratory investigations. Serum ferritin level was estimated by IRMA technique. Result and Observation : The incidence of HbE disease (E/E), trait (A/E) and HbE-thalassaemia (E/F) was 47.5%, 42.5%& 10% respectively. Most of the patients were in their second and third decade (57.5%). Male female ratio was 13:7, most being Ahom (60%) and Kochari (12.5%). The haemoglobin concentration in A/E, E/E and E/F were 8.94±0.928, 8.04±0.8840 and 6.02±0.1500; serum ferritin level 24.95±11.90, 162.26±59.5 and 1017±322.19 respectively. E/E patients on blood transfusions have a higher level of serum ferritin (122.85±4.95) than those without transfusions (95.75±9.54). Again those cases of E/F on regular blood transfusions have a higher ferritin (1260±188.14) level than those with occasional transfusions (715±155.80). Conclusion : Serum ferritin assay IRMA technique is simple and suitable for evaluation of serum iron status. Iron deficiency may be seen among HbE trait but normal or higher serum ferritin in E/E and E/F cases in this study suggests that indiscriminate iron therapy could be harmful in most of the patients without prior evaluation of serum ferritin.

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Thanatophoric dwarfism (TD), literally meaning death seeking dwarf, is the most common form of lethal bone dysplasia characterized by severe micromelia, extra folds of skin and narrow chest. Other signs include small ribs, underdeveloped lungs, cloverleaf skull, hypertelorism and protuberant abdomen. A short neck, depressed nasal bridge and hypoplastic mandible may also be present. Hydrocephalus is uncommon but is another poor prognostic sign. The diagnosis is usually made with the ultrasonography in the second trimester. Based on the morphological characters, this condition is sub-divided into type 1 and type 2. Fetuses with this condition are either still-born or die shortly after birth. Antenatal sonographic, postpartum radiological and autopsy findings of a case of type 1 TD with a relatively uncommon association of hydrocephalus is discussed.

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The world population reached 7 billion in 2012, which is 6 billion more than in 1800. This remarkable population growth is the result of several factors like advances in the medical, technological and public health systems resulting in the control and treatment of communicable diseases, the control of pandemics, the end of large-scale wars, improvements in living conditions and the revolutions in the field of agriculture. Because of all these factors, there has been a considerable improvement in the life expectancy of human beings. There is also an alarming reduction in fertility rates. The combination of declining fertility rate and augmented life expectancies has led to a change in the demographics of the population with the strata of older individuals growing faster than the younger individuals. The aging of populations is poised to become the next global public health challenge. Advances in medicine and socioeconomic development have substantially reduced mortality and morbidity rates due to infectious conditions and, to some extent, non-communicable diseases. These demographic and epidemiological changes, coupled with rapid urbanization, modernization, globalization, and accompanying changes in risk factors and lifestyles, have increased the prominence of chronic non-infective conditions. Health systems need to find effective strategies to extend health care and to respond to the needs of older adults. This review highlights the pathophysiology of aging, biological and physiological changes, impact of aging on health, epidemiological transitions, multi-morbidity in elderly and challenges for health care system.

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Background: Hepatitis B virus (HBV) infection is a global public health challenge. Health care workers (HCWs) have an extra risk of getting infected from their workplace. This study aimed at estimating prevalence of HBV infection and vaccination compliance among HCWs in a tertiary hospital in Chittagong, Bangladesh. Materials and Methods: Data were obtained from a stratified survey conducted in a tertiary care hospital Chittagong, Bangladesh among HCWs in the year 2012. A proportionate to size random sample was drawn per HCWs category. A structured questionnaire was used to collect data on sociodemographic characteristics and risk factors. With 10 ml collected venous blood enzyme-linked immunosorbent assay (ELISA) techniques were used to test sera for hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and total hepatitis B core antibody (anti-HBc). Descriptive models were used for analysis with the software SPSS-20. Results: Among the 113 participants, the overall seroprevalence of HBsAg, anti-HBs, and anti-HBc was 8%, 30.1%, and 48.7%, respectively. Fifty-four (47%) subjects were vaccinated. A significantly higher prevalence of vaccination compliance rates was observed among doctors (100%) and nurses (44.4%) than technicians (45%) and assistants (47.8%). Among the 113 subjects, 2 (22.8%) doctors were anti-HBc-positive though all of them were vaccinated and 19 (52.8%) nurses, 7 (17.5%) technicians, and 6 (30.0%) assistants were anti-HBc-positive. Among all the participants, 30.7% HCWs were susceptible to infection of HBV and could potentially be protected through vaccination. Conclusions: A significant numbers of HCWs are unvaccinated even at health care center of tertiary care level suggesting a need for early implementation of HBV vaccination program.

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Background: The family has a significant role both in the genesis and prognosis of obsessive-compulsive disorder (OCD). Early identification, treatment and prevention of relapse in patients with OCD have important therapeutic and psychosocial implications. Hence, to study and determine family factors like high expressed emotion (EE) and family dysfunction are essential. These two factors play a significant role in the relapse and course of OCD. Aim: The aim was to study the relationship between family function, EE and OCD. Materials and Methods: The sample included 30 patients who were diagnosed with OCD using International Classification of Diseases-10 Diagnostic Criteria for Research criteria. Yale-Brown obsessive compulsive scale was used to assess the severity of OCD. EE was assessed in cases using Family Emotional Involvement and Criticism Scale and family function was assessed in cases using the family interaction pattern scale (FIPS). Statistical analysis was performed using Statistical Packages for Social Science. Patient and caregivers of the patients were assessed on self-developed socio-demographic proforma. Pearson co-relation co-efficient test was used to study the correlation between OCD, high EE and family dysfunction. Results: The result showed that there are significant correlations between high EE, family dysfunction and OCD. The Pearson correlation co-efficient between OCD and EE shows a significant correlation between the high EE of the caregiver and OCD with P < 0.01. The Pearson correlation co-efficient between OCD and Family Interaction Pattern Scale shows a significant correlation between the family dysfunction of the caregiver and OCD. Conclusion: Impaired family function and high EE in caregivers associated with OCD. Thus clinical interventions may improve the functional abilities of the caregivers.

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Background: Spinal cord injury (SCI) management requires extended acute care and life-long chronic care. Aims: The present study was conducted to mobilize complete SCI patients early during conservative treatment and follow them up at the same time weekly for 6 weeks. Materials and Methods: This study was conducted in a time span of 2 years in a tertiary care hospital of Eastern India. All SCI patients admitted in the hospital for the treatment were assessed clinicoradiologically for the level of lesion. Those complete SCI patients who did not recover within 3 weeks of conservative treatment were mobilized with orthosis and efforts were done to recover the activities of daily living (ADL). The effects of early mobilization were monitored and noted at weekly interval with serial radiographs for increasing vertebral collapse and displacement and neurologically up to 6 weeks in the hospital and monthly for a time span of 1 year. Results: Results clearly indicated that guarded mobilization with braces on does not further aggravate the deformity. Bed sores occurred in 8% of cervical cord injury (CCI) and 7% of D-L injury. Respiratory infections occurred in 8% of CCI and 5% of D-L injury. Urinary tract infection affected 12% of CCI and 10% of D-L injury, and the incidences were lower when compared to previous studies, and this may be attributed to early mobilization. Conclusions: Complete SCI patients may be discharged from the hospital within 6 weeks of sustaining an injury with added training for ADL to reduce the social burden in developing countries.

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Creutzfeldt-Jakob disease (CJD) is a rare, fatal neurodegenerative disease caused by an infectious protein called prion and is characterized by spongiform changes, neuronal loss, reactive astrocytic proliferation, and accumulation of pathologic cellular protein. Clinical presentation of CJD is characterized by rapidly progressive dementia, neurologic symptoms and visual impairment, and the development of akinetic mutism, which can mimic many neurological conditions. The diagnosis is based on clinical presentation, electroencephalogram, and typical cerebrospinal fluid and magnetic resonance imaging (MRI) findings. Literature on the incidence and prevalence of CJD is lacking in South India. We report the case of a 57-year-old woman with progressive dementia and typical neurologic symptoms, myoclonic jerks, and MRI findings of CJD. This case highlights the need for a high index of suspicion to diagnose CJD.

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Background and Objective: Intentional self-poisoning is a major problem in developing countries. Thus, the main objective of this study was to characterize the poisoning cases and related mortality among patients admitted with poisoning in a tertiary care hospital during the period from April 1, 2005 to March 31, 2010. Materials and Methods: A retrospective study conducted on hospitalized patients admitted with poisoning. Data were collected from the registers kept in the medical records department, which follows the guidelines of International Classification of Diseases-10 coding. Results: Of 2018 cases, 1178 (56.6%) were males and 903 (43.4%) females. Most of the cases were in the age of 26-45 years. Of the total cases, 412 (19.8%) admitted with organophosphorus and carbamate insecticides poisoning. Among them, males 264 (22.4%) were more than females 148 (16.4%). Case fatality rate due to poisoning was 7.8% (162 deaths). Of the total deaths, 66.0% were occurred among males and 34% among females. Of the deaths, 35.2% deaths were due to organophosphorus and carbamate insecticides poisoning. Case fatality due to organophosphorus and carbamate insecticides poisoning was 13.8%. Conclusion: In the present study organophosphorus and carbamate insecticides poisoning cases and its mortality were high. The easy availability of dangerous poisons from the shops should be restricted for controlling these types of poisonous deaths.

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We are reporting a case of the safe removal of the iron intraocular foreign body embedded on the iris with the use of forceps. Preoperative best-corrected visual acuity was 20/20. Cornea showed self-sealed entry site with no other ocular injury. With such good vision, there is a definite challenge to maintain vision and avoid subsequent serious complications. The foreign body was successfully removed via limbal route with use of forceps. Postoperative best corrected visual acuity was 20/20 with very minimal surgical damage.

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Meckel diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract, occurring in 2-3% of the population. Littré hernia (LH) is the protrusion of MD through a potential abdominal opening in a sac. It results from improper closure and absorption of the omphalomesenteric duct. Protrusion of MD, along with coils of the intestine into the hernia sac may cause complications like obstruction, perforation, or fecal fistula. We report a very rare case of LH who presented with an irreducible mass in the left inguinal site, diagnosed preoperatively as incarcerated inguinal hernia in a 2-year-old boy.

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Aim: The aim of this study was to evaluate the effect of Dipteracanthus prostratus extracts on 1,2-dimethyl hydrazine (DMH) induced colon cancer in rats. Materials and Methods: To achieve this objective DMH model was selected to evaluate the effect of D. prostratus extracts on colon cancer. The study was carried out on 48 male Wistar rats divided into six groups. Group I served as a control. Groups II and III served as a positive control received ethanolic extract (500 mg/kg) and aqueous extract (500 mg/kg), respectively. Group IV served as a tumor bearing group received (20 mg/kg) DMH. Groups V and VI served as a treatment group received DMH (20 mg/kg) + ethanolic extract (500 mg/kg) and aqueous extract (500 mg/kg), respectively. Lipid peroxidation (LPO) was studied by measuring the formation of thiobarbituric acid reactive substances, catalase (CAT), glutathione peroxidase (GP _X ), and reduced glutathione (GSH) in the liver and colonic tissues of DMH administered rats. Results: (1) Decreased levels of LPO in the colonic tissues; (2) decreased activities of antioxidant enzymes LPO, CAT, GP _X , and GSH levels in the tissues on DMH treatment. D. prostratus supplementation during the entire period stages of carcinogenesis significantly reversed these activities. Conclusion: These results indicate that D. prostratus may be a potential chemopreventive agent against DMH induced colon cancer.

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Background: Globally, Staphylococcus aureus is considered the most common cause of nosocomial infections. In recent times, there is a steady rise in the number of methicillin resistant S. aureus (MRSA) isolates. Aim: This study was done to find out the prevalence, antimicrobial sensitivity pattern and evaluation of different methods (cefoxitin disc diffusion [DD] method, Chrom agar and polymerase chain reaction [PCR]) in the detection of MRSA. Materials and Methods: A total of 100 S. aureus isolates from pus samples were identified by standard biochemical techniques. Antimicrobial susceptibility testing was done by Kirby Bauer's DD method as per Clinical and Laboratory Standards Institute guidelines. D test was done to detect clindamycin resistance. Methicillin resistance was evaluated by cefoxitin DD method, Chrom agar (HiCrome MeReSa agar base and selective supplement) and reverse transcription-PCR. Result: Out of 100 S. aureus isolates, 34% were detected as MRSA by cefoxitin DD method. All these isolates were detected by Chrom agar within 24 h. Additional isolates were not detected even after 48 h of incubation. mecA gene was detected by PCR in all these 34 MRSA isolates. Conclusion: The early detection of MRSA is of prime importance in the prognosis of staphylococcal infections. An integrated awareness program, good hand wash technique, epidemiological studies and effective control measures are the goals for elimination of MRSA in hospitals.

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Background: This randomized controlled trial (RCT) aims to evaluate the effect of structured exercise therapy on different mentioned neurophysiological and cognitive functions of patients diagnosed with type 2 diabetes mellitus (T2DM). It is well known from the literature that neurophysiological and cognitive disturbances are of the complications of diabetes mellitus. Although studies have shown that exercise enhances cognitive abilities in normal individuals, previous studies that have found improvement in cognitive dysfunctions in older T2DM patients with exercise regimens were not conclusive. The earlier studies were limited to a single measure of cognitive function or short follow-up times; also there is almost no evidence of the effect of exercise on cognitive function in young adult T2DM patients. Methods/Design: This is an RCT that has enrolled a total of 146 patients with T2DM divided equally into a diabetic group and an interventional group. Seventy-three sex-, age-, and mean education level-matched subjects have been enrolled as healthy controls, comparing mentioned parameters evaluating neurophysiological and cognitive functions. The intervention therapy will be delivered at the Physiology Research Laboratory as an individually designed program of regular exercise consisting of aerobic and resistance exercises. Discussion: The results of this trial will provide novel data to indicate whether exercise improves cognition for a vulnerable group of young adults, and will set the stage for larger trials to further examine potential protective and disease-modifying effects of exercise on the brain. Ethical Clearance No: Ref. No.KLEU/Ethic/2012-13/D-4570

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Objectives: To determine the prevalence and factor related with median neuropathy at wrist (MNW) in systemic sclerosis patients. Study Design: Cross-sectional study. Setting: Srinagarind Hospital, Khon Kaen, Thailand. Participants: Systemic sclerosis patients who attended the Scleroderma Clinic, Srinagarind Hospital. Materials and Methods: Seventyfive systemic sclerosis patients were prospectively evaluated by questionnaire, physical examination, and electrodiagnostic study. The questionnaire consisted of the symptoms, duration, and type of systemic sclerosis. The physical examination revealed skin score of systemic sclerosis, pinprick sensation of median nerve distribution of both hands, and weakness of both abductor pollicis brevis muscles. The provocative test which were Tinel's sign and Phalen's maneuver were also examined. Moreover, electrodiagnostic study of the bilateral median and ulnar nerves was conducted. Results: The prevalence of MNW in systemic sclerosis patients was 44% - percentage of mild, moderate, and severe were 28%, 9.3%, and 6.7%, respectively. The prevalence of asymptomatic MNW was 88%. There were no association between the presence of MNW and related factors of systemic sclerosis. Conclusions: MNW is one of the most common entrapment neuropathies in systemic sclerosis patients. Systemic sclerosis patients should be screened for early signs of MNW.

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Context: Psychiatric patients have been identified as a population at risk for cardiovascular problems. Mortality rates are higher among psychiatric patients than in the general population and pharmacological treatment may produce side-effects that affect morbidity and mortality. Most of the previous studies are cross-sectional and are done without taking the base line values and they do not mention clearly the effects of antipsychotic drugs when used for a short period. Aims: To compare the effects of Olanzapine (OLZ), Risperidone (RSP), Trifluperazine (TFP) and Haloperidol (HPL) antipsychotic drugs on various ECG Parameters. Settings and Design: Short term prospective study. Materials and Methods: All the consecutive patients attending the hospital, who mandated the use of antipsychotic drugs, were recruited. A baseline electrocardiogram (ECG) was recorded on Day 0, before starting the antipsychotic drug. ECGs were repeated on Days 1, 5 and 10 after starting the drug. A total of 71 patients were included (N = 71), of which 33 were in OLZ group (N = 33), 14 in the RSP group (N = 14), 13 in the TFP group (N = 13) and 11 in HPL group (N = 11). Statistical analysis used: The data was analysed using SPSS Ver. 14 software. Results: No statistically significant differences were found in the ECG parameters in patients on OLZ, RSP, TFP and HPL. Conclusions: Our study shows that there are no significant changes in ECG parameters after administration of OLZ, RSP, TFP and HPL. Thus all the four drugs are equally safe in healthy adults for short-term use.

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Tardive dyskinesia (TD) is a potentially serious and irreversible side effect of anti-psychotic medications. It is characterized by choreiform movements, or rhythmic abnormal involuntary movements of the face, mouth, tongue, trunk, and limbs. Although no reliable treatment for TD exists, atypical anti-psychotics are associated with a significantly lower incidence of TD than typical anti-psychotics. Recent reports suggest that atypical anti-psychotics may have a beneficial effect on TD remission. We present a case of severe oro-bucco-lingual TD, which was effectively managed with aripiprazole.

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Meckel's diverticulum is one of the many causes for small bowel obstruction. The myriad mechanisms include intussusception, volvulus or internal hernia around a persistent band, adhesions, diverticulitis, inclusion in a hernia, etc. In fact, obstruction is the second most common complication of Meckel's diverticulitis. However, small intestinal obstruction due to Meckel's knotting around a bowel loop is a rare occurrence which mandates early diagnosis and intervention to preempt resultant morbidity and mortality. Here, we present one such case along with a review of the literature.

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