International Journal of Applied and Basic Medical Research最新文献

Cholecystoduodenal and cholecystocolic fistula (CCF) is a rare condition, occurring in patients with cholelithiasis. Multiple complex fistulas are even rare. This is a case study done to detail such a rare case, very few such cases have been reported in the past studies, with cholecystoduodenal and CCF with gallstone ileus. We present the case of an 80-year-old, female diagnosed with intestinal obstruction. Intraoperatively, the gallbladder (GB) fundus forms a CCF and the body of the GB with the first part of the duodenum forms cholecystoduodenal fistula. Gallstone ileus found impacted in jejunum 35 cm distal to DJ junction. Resection of fistula tracts with primary repair of the transverse colon was done with Graham's patch repair of duodenum and fundus first cholecystectomy. Cholecysto-duodeno-colic fistulas complicated with gallstone ileus are very rare. In the case of gallstone ileus, the surgical treatment is an emergency and the only therapeutic option.

Background: Antipsychotic medication is widely recognized as a critical intervention in both acute and ongoing treatments of schizophrenia. Guidelines endorse the routine practice of monotherapy with antipsychotic medication at the minimum effective dose. Despite the recommendations, high-dose antipsychotic prescribing and polytherapy appear to be common practice.

Objective: The objective of this study was to determine the prevalence of high-dose antipsychotic prescribing in adult patients with schizophrenia in a regional Queensland hospital and to know if the prescribing practices are in keeping with the international guidelines and with the local policy introduced in December 2017.

Methods: This was a cross-sectional survey/clinical audit of 358 adult patients with schizophrenia open to the service in both community and inpatient settings. The individual prescribing practices of psychiatrists were also examined.

Results: A minority (15%) were prescribed high doses (high-dose single agent and high dose by polytherapy) and 20% were prescribed polytherapy (including high dose and within normal dose range).

Conclusion: Eighty-five percent of the patients with the diagnosis of schizophrenia open to the service were prescribed antipsychotic within the dose range. In this respect, prescribing was aligned with current evidence-based guidelines.

Background: Chemokine receptor CXCR4 is frequently present in cells of various cancers. Hence, targeted therapy using CXCR4 ligands, such as DV1 peptide, on drug-loaded nanoparticles, has the potential to enhance the efficiency of cancer treatment.

Aim: The present study created a CXCR4-targeting drug delivery system using avidin-poly (lactic-co-glycolic acid) (PLGA) nanoparticle surface tagged with biotinylated DV1 peptide ligand.

Materials and methods: A double-emulsion solvent evaporation technique was employed to prepare avidin-PLGA nanoparticles and characterized by transmission electron microscopy (TEM) and dynamic light scattering. Uptake was studied by confocal microscopy after incorporating fluorescein isothiocyanate (FITC)-labeled albumin inside the nanoparticles during their synthesis. Peptide-biotin-avidin-PLGA nanoparticles were tested in vitro on CXCR4-expressing U87MG cells. Photomicroscopy was done by a Nikon A1 Confocal Microscope, and pictures were analyzed by Nikon NIS-Elements BR software.

Results: Experimental results confirmed the specificity of DV1 peptide-tagged avidin-PLGA nanoparticles for cells expressing CXCR4 receptors. The avidin-PLGA nanoparticles were successfully synthesized and the same was confirmed by tagging them with FITC-labeled biotin.

Conclusion: Avidin-PLGA nanoparticle surface tagged with biotinylated DV1 peptide ligand has potential clinical application in the treatment of various cancers as targeted therapy for CXCR4-expressing cancer cells.

Background: Script concordance testing is widely practiced to foster and assess clinical reasoning. Our study aimed to develop script concordance test (SCT) in the specialty of otolaryngology and test the validation using panel response pattern and consensus index.

Materials and methods: The methodology was an evolving pattern of constructing SCTs, administering them to the panel members, and optimizing the panel with response patterns and consensus index. The SCT's final items were chosen to be administered to the students.

Results: We developed 98 items of SCT and administered them to 20 panel members. The mean score of the panel members for these 98 items was 79.5 (standard deviation [SD] = 4.4). The consensus index calculated for the 98-item SCT ranged from 25.81 to 100. Sixteen items had bimodal and uniform response patterns; the consensus index improved when eliminated. We administered the rest 82 items of SCT to 30 undergraduate and ten postgraduate students. The mean score of undergraduate students was 61.1 (SD = 7.5) and that of postgraduate students was 67.7 (SD = 6.3). Cronbach's alpha for the 82-item SCT was 0.74. Excluding the 22 poor items, the final SCT instrument of 60 items had a Cronbach's alpha of 0.82.

Conclusion: Our study revealed that a consensus index above 60 had a good item-total correlation and be used to optimize the items for panel responses in SCT, necessitating further studies on this aspect. Our study also revealed that the panel response clustering pattern could be used to categorize the items, although bimodal and uniform distribution patterns need further differentiation.

Background: Achromobacter causes opportunistic nosocomial infections in immunocompromised patients with high mortality. It is underreported as it is often misidentified by conventional microbiological methods.

Aims: The aim of the study is to access the clinicomicrobiological profile and antibiogram of Achromobacter spp. from clinical isolates.

Materials and methods: It is an observational study done from July 2020 to December 2021 in our hospital. All nonduplicate isolates of Achromobacter from blood and respiratory samples were initially identified with VITEK-2 GN card system and further confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Antibiogram and treatment outcomes were also studied.

Results: Achromobacter spp. was isolated from 14 patients. Blood samples yielded most isolates (71.4%; n = 10) followed by tracheal aspirate and bronchoalveolar lavage fluid. Bacteremia followed by pneumonia was the most common clinical manifestation of Achromobacter infection. All the isolates were identified as A. xylosoxidans denitrificans and showed 100% susceptibility to minocycline and piperacillin-tazobactam. Diabetes mellitus and malignancy were the most common underlying condition in these patients. A favorable outcome was seen in 78.6% of the individuals with timely institution of antibiotics and proper diagnosis.

Conclusion: Infections due to Achromobacter are on the rise in developing countries like India. Resistance to many classes of antimicrobials makes its treatment more challenging therefore it should always be guided by antibiograms. The present study highlights the significance of this rare bacterium in patients with malignancies in India and advocates greater vigilance toward appropriate identification of this organism.

Context: Laparoscopic cholecystectomy (LC) is established as the gold standard for benign gallbladder disease. This study was done for the evaluation of preoperative scoring system given by Randhawa and Pujahari considering various preoperative parameters to predict difficulty in LC.

Aims: Preoperative prediction of difficult LC using a scoring system considering various preoperative factors in elective/interval LC to predict difficult gallbladder.

Settings and design: A prospective study of 120 patients admitted for LC from January 2020 to June 2021 was analyzed.

Subjects and methods: All the patients were evaluated on the basis of Randhawa and Pujahari scoring system with the following variables: age >50 years, male sex, body mass index 25.1-27.5 and >27.5 kg/m², previous abdominal surgery, prior hospitalization for gallstone disease, palpable gallbladder, gallbladder wall thickening, impacted stone, and pericholecystic collection. Each variable had given a score. Based on these findings, the surgical procedure was defined as easy, difficult, and very difficult.

Results: One hundred and twenty cases satisfying the inclusion criteria were studied comparing different variables and assigned preoperative scoring. A score >5 was considered significant and compared with intraoperative findings. Out of 53 patients having preoperative scores >5, 40 were difficult gallbladders and 13 were easy to operate. Prediction came true in 93.0% of difficult cases and 83.1% of easy cases.

Conclusions: From this study, we can conclude that the preoperative scoring system is statistically reliable to predict difficulty in LC in the majority of the cases (area under receiver operator characteristics = 0.935).

Carbamazepine is a commonly used drug in psychiatric settings used for indications such as partial seizures, generalized tonic-clonic seizures, mixed seizure patterns, pain associated with trigeminal neuralgia, acute manic, and mixed manic states. However, this drug comes with its own series of adverse effects such as nausea, vomiting, diarrhea, dizziness, hyponatremia, headaches, and dry mouth. One serious side effect which is rarely documented includes "carbamazepine-induced pancytopenia." In this case report, we wish to highlight a known case of schizophrenia, who was taking tablet carbamazepine as adjunctive treatment and subsequently developed pancytopenia. On removing the offending agent, her counts gradually returned to normal. By reporting this case, we wish to emphasize regarding the importance of regular monitoring of complete blood count, which often gets neglected. Furthermore, psychoeducating patients regarding regular blood monitoring and the importance of adherence holds considerable importance in enhancing their compliance. By ensuring such simple preventive measures, such serious and unusual side effects may be averted through early detection of warning signs.

Ovarian stroma and surface epithelium develop from two different embryological primordia and give rise to tumors of distinct characteristics. The simultaneous presence of two kinds of ovarian tumors in one patient is rare. Concurrent presence of a large ovarian fibroma in one ovary, and a serous cystadenoma in the seemingly normal-looking contralateral ovary was found in a 55-year-old woman. The unusual coexistence of these tumors warrants a closer and longer follow-up of the patient. To the best of our knowledge, this is the fourth case to be reported in the literature. All surgically isolated tissues should undergo detailed histopathological examination, including normal-looking tissues which are excised as a part of the procedure.

Background: Consultation-liaison psychiatry (C-LP) is an interface between physical and psychological health where the psychiatrists become a part of the medical team for a holistic approach in the treatment of the patient.

Aims: Our study aimed to see the pattern and utility of C-LP services among inpatient referrals to the department of psychiatry.

Settings and design: This observational descriptive study recorded inpatient referrals to the department of psychiatry of a tertiary care hospital for 2 months.

Subjects and methods: The Mini-International Neuropsychiatric Interview (M. I. N. I.) was administered for identifying the comorbid psychiatric diagnoses.

Results: Most of the received inpatient referrals were for male patients (73.7%) in the age group of 30-60 years (58%). Overall, the referral rate was significantly higher from the emergency department and intensive care units (ICU) (50%), followed by specialty (medicine and surgery) wards (20%) and super specialty (cardiology, gastroenterology, and oncology) wards (16%). Altered sensorium and restlessness were the most common reasons for referral (42%), followed by alcohol/drug withdrawal (21.6%), somatic complaints (7.3%), sadness of mood, disturbed sleep, and deliberate self-harm (6% each). Substance use disorders, including alcohol and opioid (32%), delirium (25%), and depression (19%), were among the most common psychiatric diagnoses seen in the referred patients.

Conclusions: The pattern observed indicates that most inpatient referrals for psychological evaluation are received for altered sensorium from emergency and ICU than wards. The utility of C-LP helps to understand the reciprocal interdependence between the medical illness and the psychiatric comorbidity.