Background: Sacral hiatus is nonfusion of the lamina of a fifth sacral vertebra in midline on the dorsal surface. The caudal epidural block is a common technique to introduce a needle into epidural space through sacral hiatus for surgical anesthesia and analgesia. Aim: The objective was to study the morphological and morphometric variations of sacral hiatus and sacral canal in human sacra and to provide bony parameters for localization of sacral hiatus as an important landmark to access the epidural space for various clinical procedures successfully. Materials and methods: The study was executed on 88 dry adult human sacra to scrutinize certain parameters of sacral hiatus and sacral canal including the shape of sacral hiatus, level of apex and base of sacral hiatus, length of sacral hiatus, anteroposterior distance at apex of sacral hiatus and intercornual distance at the base of hiatus. Results: Inverted ‘U’ shape was most frequent (35.22%) followed by inverted ‘V’ shape (29.24%). The apex and base of sacral hiatus were commonly found at fourth (57.54%) and fifth (92.04%) sacral vertebral level respectively. The mean length of sacral hiatus was 28.17 ± 16.62 mm, the anteroposterior diameter at the apex of sacral hiatus was 6.66 ± 2.71 mm, and the intercornual distance at the base was 16.39 ± 3.44 mm. Conclusion: Thorough knowledge of relevant anatomy and anatomical variations of sacral hiatus are imperative for clinicians for successful caudal epidural anesthesia. Clinical significance: During caudal epidural anesthesia, incorrect needle placement in sacral hiatus may result in intraosseous drug toxicity and aspiration. Awareness about sacral hiatus and its variations may improve the understanding of disorders related to sacral nerve injuries.
Diabetes mellitus (DM) becoming pandemic and India is toward the capital of DM. Artificial sweeteners were extensively introduced into our diet with the intention of reducing caloric intake/ weight management. Several studies investigated its benefits as well as the health issues. Aim: The present study was aimed to evaluate whether there is any change in blood sugar level after consuming artificial sweeteners. It also focused to determine artificial sweetener with less effect on blood sugar level. Materials and methods: Healthy individuals (n = 30) of 18–25 years with normal body mass index (BMI) (19–25 kg/m2) and without any preexisting diseases were selected for the study. Fasting blood specimens and 1 hour after intake of glucose and artificial sweeteners, aspartame sucralose, stevia and saccharin (equivalent to 15 g of sugar with 200 mL of water) were collected. The significance of levels of glucose was studied with student's t-test and one-way analysis of variance (ANOVA). Results: The mean fasting blood glucose concentration of all participants was in the range of 71.71 ± 8.27 to 80.94 ± 7.30 mg%. The mean glucose level after one hr of intake of glucose was 80.42 ± 8.97 mg%, and that of artificial sweeteners ranged from 74.42 ± 8.34 to 83.19 ± 5.62. A statistically significant decrease (p <0.001) compared to the glucose intake has been observed in the difference in the glucose levels between the two samples. There was minimal increase in the blood glucose concentration after intake of the artificial sweeteners. Conclusion: There was increase in the blood glucose level after the intake of artificial sweeteners and it was less compared to the glucose consumption. There was no difference in the values among the four artificial sweeteners, saccharine, aspartame, sucralose, and stevia. Stevia, being a natural product and having less side effect as compared to other artificial sweeteners, it can be suggested for incorporating as sugar substitute in dietary products.
Background: Police information (PI) is a clinician's legal duty in medicolegal case (MLC). But informing late or not informing or informing inadequately or deceptively is questionable and debatable. Mistake, glitches, and flaws in police information do embarrass clinicians. The embarrassments of the clinician usually go unreported. This is a study on real mistakes and embarrassments in which clinician faced investigators ire while explaining one's stand in favor or against considering the MLC. Aim and objectives: To study the expectation and demand of PI. It is also to know and identify how embarrassments took place, who embarrassed and who tried to hide the reality. Materials and methods: A retrospective study of cases with respect to patient's presentation vis-à-vis clinician's role and investigational expectations and ultimate outcome. Results Witch hunting in self-inflicted injury (SII) and self-suffered injuries (SSI) makes PI crucial. Probe unearth conspiracy and the clinician's role. It was too difficult for a clinician to appear genuine where he looked to a part of the conspiracy. Mistakes in deciding the issue of the MLC or nonmedicolegal NMLC usually are due to deceptive tampered background story, false implicating tendencies. Conclusion: SSI of the type of firearm injury, sharp weapon injury and digital fracture are as much a headache for the clinician as for the investigators. Consequences of misinformation affect clinician not only as an individual but also affect the profession. The message should be clear and loud that the witch hunt should not start from the clinician's information to the police. The obsession to get the things manipulated makes clinician's performance suspicious. Exclusion of MLC from the nonmedicolegal case (NMLC) was not as easy as it looked. Clinicians need to act proactively. Interested parties might oppose a proactive role in sending information.
Aim: Anterior belly of digastric muscle forms the boundary of submental and submandibular triangles, and is an important surgical landmark of the suprahyoid region. It attaches above to the digastric fossa on the mandible and below to the intermediate tendon of the muscle. Materials and methods: Thirty formalin-embalmed cadavers were examined for variations in the anterior belly of digastric muscle. Results: Anomalous muscles were seen in two cases (6.6%), one unilateral and one bilateral. Anterior belly of digastric muscle was absent on the left side in one cadaver. Symmetrical appearance of accessory muscles, medial and parallel to the main bellies was noted in the bilateral case. Conclusion: Variations in the anterior belly like the presence of accessory fibers or absence of the anterior belly alter the anatomic layout of the region between the mandible and hyoid bone, which is relevant for clinicians, surgeons, and radiologists dealing with the suprahyoid area. Clinical significance: Atypical anterior belly of digastric muscle is likely to affect the movements of joints involving mandible and hyoid, surgical interventions in the suprahyoid region, and the interpretation of diagnostic scans.
Cancer has become a leading cause of mortality worldwide, next only to cardiovascular diseases. Patients who develop cancer are known to exhibit several genomic alterations. Conventional therapies for the management of cancer have their own limitations. Immunotherapy is coming up as a promising new option for millions of patients who are suffering from end stage metastasis or refractory malignancies. To this end, the goal of cancer immunotherapy is to recruit and potentiate immune cells that can generate a robust and long lasting immune response and specifically target the cancer cells with minimum damage to normal cells. These treatment strategies, when used either alone or in combination, are known to significantly effect tumor growth and have even produced cures. In this brief review, some of the most popular cancer immunotherapy approaches shall be reviewed. Recent data from clinical trials suggest that combining more than one immunotherapy mechanisms, in conjunction with other treatment options like chemotherapy, radiotherapy and targeted therapy , may be the way forward to a complete cancer cure.
Aim: This review aims to reassess the role of saturated fatty acids (SFAs) in the diet in light of recent evidence which shows that consumption of SFAs is probably safer than previously thought. Background: SFAs are an integral component of dietary fat. The association between SFAs and non-communicable diseases has been studied and debated for decades. The belief about the adverse effects of SFAs has been challenged by some recent studies and meta-analyses which depicted that consumption of carbohydrates rather than SFAs is possibly the main culprit for the causation of noncommunicable diseases. This has raised the need for reassessment of dietary guidelines for saturated fat consumption. Review results: There is no consensus on incriminating SFAs for ill health. Some studies have shown adverse effects of SFA on health whereas other studies have failed to do so. Recent analysis suggests that there is no association of SFA consumption with an increased incidence of non-communicable diseases. However, consumption of trans fats, especially the industrially derived ones, is associated with the adverse outcomes. Conclusion: Recent advanced statistical techniques, large scale meta-analysis and interventional trials on specific SFAs on disease outcome have been changing the concept and understanding over the last few years. It has well been understood that replacing carbohydrates for SFAs has been associated with more adverse outcome. Recent systematic reviews and meta-analyses have disproved the older concept about the deleterious effects of SFAs. Clinical significance: Consumption of SFAs is probably safe. The intake of industrialized fats, trans fats, and red meat should be limited.
DOI: 10.5005/jp-journals-10070-0022 |
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Kumar N, Shankar MM. Practice Changing Continuing Education: A Critical Review of Neurological Complications in Acute Pancreatitis. Journal of Medical Academics 2018; 1 (2):109-110.
This uncommon syndrome of pancreatic encephalopathy was first described in 1923. A manifestation of multiple organ dysfunction syndromes, generally occurs in the early stage of severe acute pancreatitis and carries high mortality of up to 57% and more. The syndrome must be distinguished from Wernicke encephalopathy, which may follow as a part of neurological complications in the last or recovery phase of acute pancreatitis, and occurs as a result of long fasting, hyperemesis and total parenteral nutrition without thiamine. Poorly recognized by clinicians, a large dose of vitamin B1 is effective in the management of Wernicke encephalopathy. In view of above the present review draws attention to the challenging and lesser recognized complications of acute pancreatitis and briefly dwells on their pathogenesis and management.
Shaifaly M Rustagi,
Manish S Ahuja,
ABSTRACT The peroneus quartus (PQ), a supernumerary muscle of the ankle is located in the lateral compartment of the leg. Its most common origin is from the peroneus brevis muscle and insertion into the retrotrochlear eminence of the calcaneus. We observed an unusual variant of the muscle arising from the lateral surface of fibula between the two peroneal muscles. The tendons were crowded beneath an overhanging lateral malleolus. The muscle was found to be inserted onto the peroneal trochlea. The presence of this muscle has been the cause of lateral ankle pain and swelling. It has been implicated in tears and subluxation of peroneus brevis and tenosynovitis of peroneal tendons
The present case report shows us an insight into recent medical imaging, new innovations and techniques of abdominal scan acquisition using dual energy. The primary objective was attaining a feasible site for tissue biopsy and secondary objective was proper anatomical delineation of pathology using cinematic VRT images. VNC and mixed images reveal the mesentric mass and provide a favorable outcome on the biopsy selection site.