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Are donor predonation variables related to the quality of single donor platelets? – A tertiary care center experience 供体预处理变量是否与单个供体血小板的质量有关三级护理中心体验
Q4 Medicine Pub Date : 2021-01-01 DOI: 10.4103/jms.jms_108_20
P. Chatterjee, S. Sehgal, Swati Bhardwaj, R. Bhushan, Chintamani Pathak, M. Jain
Introduction: Platelets are the most common product collected by apheresis. The product obtained is called single donor platelets (SDPs). The quality of the SDP is determined by the platelet yield (that is platelet count of the SDP product), which in turn directly influences the patient recovery. Materials and Methods: In the present study, donor demographic and complete blood count parameters were studied and their influence on the yield of the SDP was analyzed. With such an analysis, a better quality product (with a good platelet yield) can be obtained consequently improving clinical outcome. This would allow prolonging intervals between transfusions. Results: Parameters such as height, weight, and body mass index did not statistically influence the platelet yield in this study, unlike the results obtained by past studies. The most consistent parameter found to influence the platelet yield was platelet count of the donor. Healthy donors with high platelet counts can yield better platelet yield in SDPs in a shorter time and therefore improve the clinical outcome in patients with thrombocytopenia. Conclusion: It is important to consider hematological characteristics of the donors on an individual basis so as to ensure a good quality of the plateletpheresis product.
简介:血小板是单采采集的最常见的产品。所获得的产物被称为单供体血小板(SDPs)。SDP的质量由血小板产量(即SDP产品的血小板计数)决定,而血小板产量又直接影响患者的康复。材料和方法:在本研究中,研究了供体人口统计学和全血细胞计数参数,并分析了它们对SDP产量的影响。通过这样的分析,可以获得质量更好的产品(具有良好的血小板产量),从而改善临床结果。这样可以延长输血间隔时间。结果:与过去的研究结果不同,身高、体重和体重指数等参数在本研究中对血小板产量没有统计学影响。发现影响血小板产量的最一致的参数是供体的血小板计数。具有高血小板计数的健康供体可以在更短的时间内在SDP中产生更好的血小板产量,从而改善血小板减少症患者的临床结果。结论:重要的是要在个体基础上考虑捐献者的血液学特征,以确保血小板置换产品的良好质量。
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引用次数: 0
A review of rare palatal fractures and their management 罕见腭部骨折及其治疗综述
Q4 Medicine Pub Date : 2021-01-01 DOI: 10.4103/jms.jms_35_21
Umesh Kumar, P. Jain
Objective: The objective of this study was to diagnose rare palatal fractures and to subcategories them to formulate a definitive treatment plan depending upon the fracture lines. Materials and Methods: All patients presenting in triage with palatal fractures were classified after computed tomography scan. Thirteen patients diagnosed with complex and transverse palatal fractures were included in the study. Complex fracture was further subdivided into five groups: (a) comminuted, (b) oblique, (c) S shaped, (d) C shaped, and (e) T shaped. The patients were divided into two groups. In Group A, six patients were managed without palatal vault plating, and in Group B, seven patients were managed with palatal vault plating along with anterior alveolar and anterior maxillary buttress plating. Results: Twelve patients presented with complex fracture and one patient presented with transverse fracture. The male-to-female ratio and age range of the study were 5.5:1 and 15–55 years, respectively.Le Fort I and II fracture was present in five patients, isolated Le Fort II fracture in four patients, Le Fort I was present in two, and Le Fort I, II and III fractures was present in two patients. Conclusion: Complex palatal fractures can be subcategorized which simplifies the management and documentation of the fracture. Palatal vault plating should be attempted in cases where there are two large fracture segments to achieve the better stability of fracture and reduce the duration of maxillomandibular fixation in postoperative period.
目的:本研究的目的是诊断罕见的腭骨折,并根据骨折线对其进行亚分类,以制定明确的治疗计划。材料与方法:所有腭裂分诊患者均经计算机断层扫描后进行分类。13例诊断为复杂和横向腭骨折的患者纳入研究。复杂骨折进一步细分为五组:(a)粉碎性骨折,(b)斜骨折,(c) S型骨折,(d) c型骨折,(e) T型骨折。患者被分为两组。A组6例患者不做腭穹窿镀板,B组7例患者同时做腭穹窿镀板和前牙槽及上颌前支撑镀板。结果:复杂骨折12例,横骨折1例。研究的男女比例为5.5:1,年龄范围为15-55岁。1、2型骨折5例,孤立性2型骨折4例,1型骨折2例,1、2、3型骨折2例。结论:复杂腭骨折可进行分类,简化了骨折的处理和记录。对于有两个较大骨折节段的病例,应尝试腭弓钢板,以获得更好的骨折稳定性,减少术后上下颌固定时间。
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引用次数: 0
Tubular adenoma of the breast: A rare entity 乳腺管状腺瘤:一种罕见的实体瘤
Q4 Medicine Pub Date : 2021-01-01 DOI: 10.4103/jms.jms_6_21
L. Simon, Moirangthem Singh, Angelica Laiphrakpam, L. Devi
Tubular adenoma is a rare benign neoplasm of the breast. It is commonly seen in premenopausal women and has no association with an increased risk of breast cancer. It is difficult to diagnose tubular adenoma clinically, radiologically, and cytologically. Histopathological examination remains the gold standard in diagnosing tubular adenoma.
管状腺瘤是一种罕见的乳腺良性肿瘤。它常见于绝经前妇女,与癌症风险增加无关。管状腺瘤的临床、放射学和细胞学诊断都很困难。组织病理学检查仍然是诊断管状腺瘤的金标准。
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引用次数: 0
Clinicopathological study of papulosquamous skin disorders in a tertiary health-care center 某三级保健中心丘疹鳞状皮肤病的临床病理研究
Q4 Medicine Pub Date : 2021-01-01 DOI: 10.4103/jms.jms_18_21
R. Shimray, S. Laishram, G. Pukhrambam, K. Devi, Paramita Pal
Background: Papulosquamous skin disorder is a group of heterogenous dermatoses with a distinct histomorphological feature. The characteristic primary lesion is a papule, usually erythematous, that has a variable amount of scaling on the surface. The most common papulosquamous dermatoses are psoriasis, lichen planus, and pityriasis rosea. Because all papulosquamous disorders are characterized by scaling papules, clinical confusion may result during their diagnosis. Our study is to evaluate histomorphological findings in various papulosquamous skin disorders encountered at RIMS, Imphal. Materials and Methods: Skin biopsies of clinically diagnosed papulosquamous skin disorders along with their relevant clinical data received during a period of 2 years from September 2017 to August 2019 were included in the study. The diagnosis was confirmed by histopathological examination using hematoxylin and eosin stain. Results: A total of 115 papulosquamous skin disorders were studied with 75 cases of psoriasis (11–80 years), 36 cases of lichen planus (2–70 years), and 4 cases of pityriasis rosea. Age ranges from 2 to 80 years. Maximum cases were seen in the age group of 31–50 (70.6%) with a mean age of 39.18 years. Both genders were almost equally affected with a male: female ratio of 1.13:1. An analysis of the clinical with histopathological diagnosis of these papulosquamous skin lesions revealed a positive correlation in 76 (66.08%) cases and a negative correlation in 39 (2.9%) cases. Conclusion: Because of the varied clinical presentation and histopathological patterns of papulosquamous skin disorder, it is important to characterize the types of papulosquamous lesions as far as possible for definitive treatment.
背景:丘疹鳞状皮肤病是一组具有明显组织形态学特征的异质性皮肤病。特征性原发病变为丘疹,通常为红斑,表面有不同数量的鳞屑。最常见的丘疹鳞状皮肤病是牛皮癣、扁平苔藓和玫瑰糠疹。因为所有丘疹鳞状疾病的特点是鳞状丘疹,临床混淆可能导致在他们的诊断。我们的研究是评估组织形态学的发现在各种丘疹鳞状皮肤疾病遇到的rim, impal。材料与方法:纳入2017年9月至2019年8月2年间临床诊断为丘疹鳞状皮肤病的皮肤活检及相关临床资料。经苏木精和伊红染色组织病理学检查证实。结果:共对115例丘疹鳞状皮肤病进行了研究,其中银屑病75例(11 ~ 80岁),扁平苔藓36例(2 ~ 70岁),玫瑰糠疹4例。年龄从2岁到80岁不等。以31 ~ 50岁年龄组最多(70.6%),平均年龄39.18岁。男女受影响几乎相等,男女比例为1.13:1。临床病理分析显示76例(66.08%)呈阳性,39例(2.9%)呈阴性。结论:由于丘疹鳞状皮肤疾病的临床表现和组织病理模式各不相同,因此尽可能明确丘疹鳞状病变的类型对于明确治疗至关重要。
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引用次数: 0
A community-based study to assess the perceptions and barriers in utilization of no-scalpel vasectomy among married men in a rural area of South India 一项基于社区的研究,旨在评估南印度农村地区已婚男性在使用无手术刀输精管切除术方面的认知和障碍
Q4 Medicine Pub Date : 2020-09-01 DOI: 10.4103/jms.jms_126_20
P. Shrivastava, S. Shrivastava
Background: India is the second most populous country in the world after China. In 1992, the government introduced an innovative technique “no-scalpel vasectomy” (NSV), a simpler, safer, and cheaper method aimed at increasing male participation in family planning. Despite the many advantages over female sterilization techniques, NSV still accounts for <1% of all the family planning methods used in India. Hence, this study was conducted among married men in a rural area to assess their knowledge and perceptions regarding NSV and identify various barriers in utilization of NSV. Materials and Methods: A community-based cross-sectional descriptive study was carried out for 6 months in the rural field practice area of a tertiary care hospital in Chengalpet district among a total of 170 married men in the age group of 21–60 years. Systematic random sampling was used to identify the study participants, and all the eligible participants were interviewed using a pretested semi-structured schedule. Data entry was done in Microsoft Excel, and analysis was done using the Statistical Package for the Social Sciences, version 23. Results: Good knowledge level about NSV was found in only 21 (12.4%) participants. Among the 170 study participants, only 2 (1.2%) had undergone vasectomy. The most common barriers to utilization of NSV were found to be availability of alternative methods of contraception by 136 (80%) participants followed by misconceptions about the procedure of NSV in 134 (78.8%) participants. Conclusion: The study highlights the urgent need to overcome the misconceptions and sociocultural concerns not only regarding NSV but also about the importance of male involvement in family welfare by targeted interventions in order to boost the acceptance of this simpler terminal contraception method.
背景:印度是仅次于中国的世界第二人口大国。1992年,政府推出了一种创新技术“无手术刀输精管切除术”(NSV),这是一种更简单、更安全、更便宜的方法,旨在增加男性对计划生育的参与。尽管NSV比女性绝育技术有很多优势,但在印度使用的所有计划生育方法中,NSV仍占不到1%。因此,本研究在农村地区的已婚男性中进行,以评估他们对NSV的知识和看法,并确定使用NSV的各种障碍。材料和方法:在Chengalpet区一家三级护理医院的农村实地实践区,对170名21-60岁的已婚男性进行了为期6个月的社区横断面描述性研究。使用系统随机抽样来确定研究参与者,并使用预先测试的半结构化时间表对所有符合条件的参与者进行访谈。数据输入在Microsoft Excel中完成,分析使用社会科学统计软件包,版本23。结果:只有21名(12.4%)参与者具有良好的NSV知识水平。在170名研究参与者中,只有2人(1.2%)接受了输精管切除术。发现使用NSV最常见的障碍是136名(80%)参与者可获得替代避孕方法,134名(78.8%)参与者对NSV的程序存在误解。结论:该研究强调,迫切需要通过有针对性的干预措施,克服对NSV以及男性参与家庭福利重要性的误解和社会文化担忧,以提高人们对这种更简单的最终避孕方法的接受度。
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引用次数: 0
Number of COVID-19 test and positive rate: Is there any relationship? 新冠肺炎检测数量与阳性率:有关系吗?
Q4 Medicine Pub Date : 2020-09-01 DOI: 10.4103/jms.jms_99_20
Rujittika Mungmungpuntipantip, V. Wiwanitkit
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引用次数: 0
A comparative clinical study of collagen and paraffin gauze dressing on skin donor site 胶原与石蜡纱布敷料在供皮部位的临床比较研究
Q4 Medicine Pub Date : 2020-09-01 DOI: 10.4103/jms.jms_25_21
Saugat Das, A. Singh, L. Singh, Nehar Sinam, Sanjib Singh
Background: Split skin grafting (SSG) is a commonly performed plastic surgical procedure. It is done to cover wounds, defects from excision of cutaneous lesions, donor sites of fascio-cutaneous flaps. The harvest of a split thickness skin graft causes a partial thickness injury. Complete re-epithelialization occurs in 10-14 days, although the rate may be affected by the local wound environment. However, tissue desiccation and infection can convert a partial thickness injury to a full thickness loss. Aims and Objectives: The purpose of the study was to determine the best method of dressing the donor site split-thickness graft between conventional paraffin gauze dressing and collagen-based dressings with respect to the rate of healing, pain, secretion, infection, and cost. Settings and Design A hospital based Non-Randomized control trial was conducted in a tertiary hospital setup in Manipur, India, for a period of 2 years. This study was done on 60 patients who underwent split skin graft procedure. Materials and Methods: The selected sample will be divided into two groups. The donor site dressing was done in two different ways. One was dressed with collagen sheet and the other with paraffin gauze dressing. The two groups were compared on the basis of post-operative pain, complication, and healing. Statistical analysis Statistical analysis was done by using IBM SPSS Version 21 for windows. Descriptive statistics such as mean, proportion, percentage were used to present the result. Chi square test was used to see the association of proportions. Student's t- test and repeated ANOVA were used for the continuous variables. P-value <0.05 was taken as significant. Results: A total of 60 patients were included in this study as per the estimated sample size. The Case group i.e., the patients for whom the STSG donor site were dressed by Collagen dressing and the Control group i.e., the patients for whom paraffin gauze dressings were used. Patients with collagen dressings are found to have only minimal to moderate pain in the entire postoperative period. In these patient's analgesic requirement is reduced, and early mobilization can be done. This is the major advantage of using collagen as a donor site dressing. We found that collagen slightly increases epithelization, which will reduce the chance of infection saving time and resources for the hospital staff and minimizing discomfort for the patient. Conclusion: In this study it was found that dressing the donor site for split-thickness graft with collagen-based dressings gave better results with respect to the rate of healing and post-operative pain scores than conventional paraffin gauze dressing.
背景:切开植皮术是一种常见的整形外科手术。它用于覆盖伤口、皮肤损伤切除后的缺陷、筋膜皮瓣的供区。切开厚度的皮肤移植物的收获会导致部分厚度的损伤。完全再上皮化发生在10-14天,尽管其发生率可能受到局部伤口环境的影响。然而,组织干燥和感染可以将部分厚度损伤转化为全厚度损失。目的和目的:本研究的目的是从愈合率、疼痛、分泌物、感染和成本等方面确定传统石蜡纱布敷料和胶原基敷料之间的供体部位中厚移植物的最佳敷料方法。设置和设计一项基于医院的非随机对照试验在印度曼尼普尔的一家三级医院进行,为期2年。这项研究是对60名接受切开植皮手术的患者进行的。材料和方法:所选样本将分为两组。供体部位的敷料有两种不同的方法。一个用胶原片包扎,另一个用石蜡纱布包扎。根据术后疼痛、并发症和愈合情况对两组进行比较。统计分析使用IBM SPSS Version 21 for windows进行统计分析。采用平均值、比例、百分比等描述性统计数据来呈现结果。卡方检验用于观察比例的相关性。连续变量采用学生t检验和重复方差分析。P值<0.05为显著性。结果:根据估计的样本量,共有60名患者被纳入本研究。病例组,即STSG供区用胶原敷料包扎的患者,对照组,即使用石蜡纱布敷料的患者。发现使用胶原敷料的患者在整个术后期间只有轻微到中度疼痛。在这些情况下,患者的镇痛需求减少,并且可以进行早期动员。这是使用胶原蛋白作为供体部位敷料的主要优点。我们发现胶原蛋白会略微增加上皮化,这将减少感染的机会,为医院工作人员节省时间和资源,并最大限度地减少患者的不适。结论:在本研究中发现,与传统的石蜡纱布敷料相比,用胶原基敷料敷料在供区对中厚移植物的愈合率和术后疼痛评分有更好的效果。
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引用次数: 2
Medical students' practice, attitudes, and motives toward physical activity: A cross-sectional study 医学生对体育活动的实践、态度和动机:一项横断面研究
Q4 Medicine Pub Date : 2020-09-01 DOI: 10.4103/jms.jms_1_21
Vanlalduhsaki, J. Laishram, B. Akoijam
Background: Medical students have substantial knowledge of the benefits of regular physical activity. A person's motives for physical activity are important in determining whether the person will be physically active. Objectives: The purpose of this study was to explore the attitude and motivation to be physically active among undergraduate medical students. Materials and Methods: This was a cross-sectional study conducted in a tertiary care medical institute in Manipur between July 18, 2016, and August 16, 2016. Self-administered questionnaire was used for data collection. Data collected were analyzed in IBM SPSS version 21. The results were summarized in frequencies and proportions for categorical variables and in means and standard deviations for continuous variables. Chi-square test, ANOVA, and Student's t-test were employed and P < 0.05 was considered statistically significant. Results: Out of 361 participants, 180 (49.9%) were females. The mean age of the participants was 22.55 ± 2.08 years (range: 18–34 years). Body mass index of majority of the participants (59%) fell within the normal range. About 62.3% of the students were currently engaged in physical activity. Attitude of the students toward physical activity was favorable and the total mean attitude score was 3.82. Intrinsic motivation was identified as the most important motive for being physically active. Conclusions: The participants displayed a favorable attitude toward physical activity with no difference in attitude compared to male and female students. Those who were active identified intrinsic motivation as the most important motive for being physically active.
背景:医学生对定期体育活动的好处有着丰富的知识。一个人进行体育活动的动机对于决定他是否会进行体育活动很重要。目的:本研究旨在探讨医科大学生体育锻炼的态度和动机。材料和方法:这是2016年7月18日至2016年8月16日在曼尼普尔一家三级医疗机构进行的横断面研究。数据收集采用自我管理问卷。收集的数据在IBM SPSS 21版中进行分析。结果总结为分类变量的频率和比例,以及连续变量的平均值和标准差。采用卡方检验、方差分析和Student t检验,P<0.05被认为具有统计学意义。结果:361名参与者中,180名(49.9%)为女性。参与者的平均年龄为22.55±2.08岁(范围:18-34岁)。大多数参与者(59%)的体重指数均在正常范围内。目前约有62.3%的学生从事体育活动。学生对体育活动的态度良好,态度总分平均3.82分。内在动机被认为是身体活动的最重要动机。结论:参与者对体育活动表现出良好的态度,与男女学生相比,态度没有差异。那些积极的人认为内在动机是进行身体活动的最重要动机。
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引用次数: 1
Knowledge of mothers and caretakers on adverse events following immunization in an urban community of Imphal 英帕尔城市社区中母亲和照料者对免疫接种后不良事件的了解
Q4 Medicine Pub Date : 2020-09-01 DOI: 10.4103/jms.jms_115_20
Vanlalduhsaki, Romola Pukh
Context: Immunization is a great success in public health and has prevented a number of diseases. Although there are some adverse effects from certain vaccines, the benefits of vaccination have resulted in significant decline in infant and childhood morbidity and mortality. Parental concerns about perceived vaccine safety issues have led increasing number of parents to refuse or delay vaccination for their children. Hence, the knowledge regarding immunization in prevention of infectious disease among mothers and caretakers of under-five children is important. Aims: We aimed to assess the knowledge of mothers/caretakers of children under 5 years of age about adverse effects following immunization. Settings and Design: It was a cross-sectional study conducted in the urban field practice area of the Department of Community Medicine, Regional Institute of Medical Sciences, Imphal. Subjects and Methods: House-to-house survey was carried out and data were collected using a semi-structured questionnaire among the mothers and caretakers of children under 5 years of age. A total of 400 participants were interviewed in the study. Statistical Analysis Used: Data were entered in IBM SPSS Statistics 21 (IBM Corp. 1995, 2012) and summarized using descriptive statistics such as percentages and proportions. Chi-square test was employed to test the association between knowledge on immunization and selected variables of interest. P < 0.05 was taken as statistically significant. Results: Out of the 400 respondents, only 23.5% had adequate knowledge regarding immunization, 19% had average knowledge, and 57.5% had poor knowledge. Mothers who were above 30 years had better knowledge than those younger (P < 0.001). The higher the education level, the better was the knowledge, and this was also significant (P < 0.001). Christians were found to have better knowledge than Hindus (P < 0.001), and working mothers had better knowledge than homemakers (P < 0.001). There was no association between type of family and knowledge. 40.3% of the respondents were aware of adverse events following immunization (AEFI), out of which 37.9% acquired it mainly from the accredited social health activists/auxiliary nurse midwives, and the most common adverse event identified was fever (87.6%). 72.2% of the respondents who had experienced an adverse event following immunization in their children reported that the event developed within 6 h. Conclusions: Nearly one-fourth (23.5%) of the participants had good knowledge about immunization and nearly half of them were aware of AEFI. The main source of immunization and AEFI was reported to be peripheral health workers. Knowledge of the participants was significantly associated with mothers' age, educational status, and religion and employment status.
背景:免疫接种在公共卫生领域取得了巨大成功,预防了许多疾病。尽管某些疫苗有一些不良影响,但疫苗接种的好处已导致婴儿和儿童发病率和死亡率显著下降。父母对疫苗安全问题的担忧导致越来越多的父母拒绝或推迟为孩子接种疫苗。因此,在五岁以下儿童的母亲和看护人中了解预防传染病的免疫知识是很重要的。目的:我们旨在评估5岁以下儿童的母亲/看护人对免疫接种后不良反应的了解。设置和设计:这是一项在英帕尔地区医学科学研究所社区医学系城市实地实践区进行的横断面研究。受试者和方法:对5岁以下儿童的母亲和看护人进行挨家挨户的调查,并使用半结构化问卷收集数据。该研究共采访了400名参与者。使用的统计分析:数据输入到IBM SPSS Statistics 21(IBM Corp.1995,2012)中,并使用描述性统计数据(如百分比和比例)进行汇总。卡方检验用于检验免疫知识与所选感兴趣变量之间的相关性。P<0.05具有统计学意义。结果:在400名受访者中,只有23.5%的人对免疫接种有足够的知识,19%的人知识一般,57.5%的人知识贫乏。30岁以上的母亲比年轻的母亲有更好的知识(P<0.001)。教育水平越高,知识越好,这一点也很显著(P<0.001。40.3%的受访者知道免疫接种后的不良事件(AEFI),其中37.9%的受访者主要从认可的社会卫生活动家/辅助助产士那里获得,发现的最常见的不良事件是发烧(87.6%)。72.2%的儿童在接种疫苗后发生不良事件的受访者报告称,该事件在6小时内发生。结论:近四分之一(23.5%)的参与者对免疫接种有良好的了解,近一半的参与者知道AEFI。据报道,免疫和AEFI的主要来源是外围卫生工作者。参与者的知识与母亲的年龄、教育状况、宗教和就业状况显著相关。
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引用次数: 0
A case series of hypokalemic thyrotoxic periodic paralysis presenting in the North Eastern region of India 一例系列低钾性甲状腺毒性周期性麻痹呈现在印度东北部地区
Q4 Medicine Pub Date : 2020-09-01 DOI: 10.4103/jms.jms_33_21
Monica Moirangthem, L. Singh, M. Janet, C. Sreejith, Tasso Opo, A. Singh
Hypokalemic periodic paralysis (HPP) with thyrotoxicosis is a rare but treatable cause of sudden onset paralysis. Its occurrence is more common in males particularly of Asian descent. Presentation is like those seen in HPP with an additional feature of a hyperthyroid state, where the symptoms of hyperthyroidism may often be mild and thus may be missed. We are reporting a series of 4 cases of HPP in two males and two females from the North eastern region of India who presented with sudden onset weakness of limbs. Although hyperthyroidism is not common in this region of the country, all of them had elevated thyroid hormone levels on further evaluation. This case series is to highlight the significance of thyroid function test in cases presenting with a history of periodic paralysis.
低钾血症性周期性麻痹(HPP)伴甲状腺毒症是一种罕见但可治疗的突发性麻痹病因。它的发生在男性中更为常见,尤其是亚洲血统。其表现与HPP相似,但有甲状腺功能亢进的附加特征,甲状腺功能亢进的症状通常很轻微,因此可能被忽略。我们报告来自印度东北部地区的两男两女4例HPP系列病例,他们表现为突然发作的四肢无力。虽然甲状腺机能亢进在该国该地区并不常见,但在进一步评估中,所有患者的甲状腺激素水平均升高。这一系列的病例是为了强调甲状腺功能测试的意义,在病例表现为周期性麻痹的历史。
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引用次数: 0
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JMS - Journal of Medical Society
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