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Dyke–Davidoff–Masson Syndrome – A Case Series 戴克-戴维多夫-马森综合征--一个病例系列
Pub Date : 2024-04-01 DOI: 10.4103/cmi.cmi_160_23
S. Sheetal, Joel Varghese Sujan, Athira Das, Vivek Mathai
Dyke–Davidoff–Masson syndrome (DDMS) refers to variable degrees of atrophy of one cerebral hemisphere, resulting from brain injury in intrauterine or early years of life. Clinical features of this rare syndrome include varying degrees of contralateral hemiplegia, facial asymmetry, seizures, and mental retardation. Specific neuroimaging findings include unilateral brain volume loss, ventriculomegaly, and compensatory bone hypertrophy. In addition to this, calvarial thickening and hyperpneumatization of frontal sinuses may occur. We hereby report three cases of this syndrome, with varied clinical and radiographic features, to highlight the wide spectrum of this syndrome.
戴克-戴维多夫-马森综合征(Dyke-Davidoff-Masson Syndrome,DDMS)是指由于宫内或出生后早期的脑损伤导致的一侧大脑半球不同程度的萎缩。这种罕见综合征的临床特征包括不同程度的对侧偏瘫、面部不对称、癫痫发作和智力低下。具体的神经影像学检查结果包括单侧脑容量减少、脑室肥大和代偿性骨肥大。此外,还可能出现颅骨增厚和额窦过度充气。我们在此报告了三例该综合征的病例,其临床和影像学特征各不相同,以突出该综合征的广泛性。
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引用次数: 0
Utility of Sensate Pedicled Medial Thigh Perforator Flaps in Treating Recurrent Ischial Ulcers in Individuals with Cauda Equina Lesions and Spinal Dysraphism – A Retrospective Analysis 有感觉带蒂大腿内侧穿孔器皮瓣治疗马尾损伤和脊柱发育不良患者复发性峡部溃疡的效用 - 一项回顾性分析
Pub Date : 2024-04-01 DOI: 10.4103/cmi.cmi_166_23
Prashanth H. Chalageri, Thomas Anand Augustine, H. Magimairaj, B. Yadav
Ischial pressure ulcers pose a significant challenge due to their high recurrence rates. It is imperative to provide or establish a reliable, well-vascularized soft-tissue cover over the ischial area to prevent recurrences. The objective of the study was to study the utility and complication rates associated with pedicled medial thigh perforator (P-MTP) sensate flap procedures in managing recurrent ischial ulcers and perineal lesions. A retrospective cohort study was conducted at Christian Medical College, Vellore, a tertiary care center in South India. This study involved 30 patients with ischial pressure sores. Of these, 13 patients underwent P-MTP flaps, while 17 underwent alternative surgeries for ulcer closure (January 2014–June 2020). Among 13 patients who underwent P-MTP sensate flaps, 1 major complication (full-thickness flap necrosis) necessitated flap revision, while 6 minor complications occurred in the postoperative period. Three patients (23.08%) reported late recurrence of ulcers at the same postoperative site. In contrast, among the 17 patients who underwent the other (alternative) methods of surgical closure, 3 patients had wound dehiscence in the postoperative period. Four patients reported recurrence of ulcer at the postoperative site within 6 months and another four after 6 months of surgical closure. The surgical outcomes in sensate flap surgeries (P-MTP flaps) were comparable to other approaches for surgical closure. Sensation in the P-MTP flap transposed over the ischial region remained intact in all 13 patients at 6-month follow-up. The P-MTP sensate flap is a feasible and reliable treatment strategy for regional soft-tissue reconstruction in ischial and perineal lesions with postoperative complications comparable to other surgical methods for ischial ulcer closure. The sensate flap surgeries offer the additional benefit of maintaining intact sensation over the pressure injury vulnerable ischial region.
骶髂部压疮因其复发率高而成为一项重大挑战。当务之急是在骶骨部位提供或建立可靠、血管良好的软组织覆盖,以防止复发。本研究的目的是研究有蒂大腿内侧穿孔器(P-MTP)感觉皮瓣手术在治疗复发性峡部溃疡和会阴部病变方面的效用和并发症发生率。 一项回顾性队列研究在南印度的三级医疗中心韦洛尔基督教医学院进行。这项研究涉及 30 名骶骨压疮患者。其中,13 名患者接受了 P-MTP 皮瓣手术,17 名患者接受了其他溃疡闭合手术(2014 年 1 月至 2020 年 6 月)。 在接受P-MTP感觉皮瓣手术的13名患者中,有1名患者因出现重大并发症(全厚皮瓣坏死)而需要进行皮瓣翻修,6名患者在术后出现了轻微并发症。3名患者(23.08%)报告术后同一部位溃疡晚期复发。相比之下,在接受其他(替代)手术闭合方法的 17 位患者中,有 3 位患者在术后出现伤口开裂。4 名患者在术后 6 个月内溃疡复发,另有 4 名患者在手术缝合 6 个月后溃疡复发。感觉皮瓣手术(P-MTP皮瓣)的手术效果与其他手术闭合方法相当。所有13名患者在6个月的随访中,转位到骶骨区域的P-MTP皮瓣的感觉仍然完好无损。 P-MTP感觉瓣是一种可行且可靠的治疗策略,可用于峡部和会阴部病变的区域软组织重建,术后并发症与其他峡部溃疡闭合手术方法相当。感觉瓣手术的另一个优点是可以保持易受压力损伤的峡部区域的完整感觉。
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引用次数: 0
Diagnosis of Cystic Fibrosis Beyond Childhood in India 印度儿童期之后的囊性纤维化诊断
Pub Date : 2024-04-01 DOI: 10.4103/cmi.cmi_150_23
Priyanka Medhi, Barney Thomas Isaac, Richa Gupta, B. Thangakunam, S. Chandy, SnehaDeena Varkki
Cystic fibrosis (CF) is a life-limiting genetic condition with multisystemic manifestations. However, there are vast phenotypic as well as genotypic variations. This contributes to delay in diagnosis, especially in pancreatic-sufficient patients who may not manifest typical symptomatology. The last decade has witnessed significant breakthroughs in CF therapeutics. This in combination with early diagnosis through newborn screening, and aggressive supportive care can offer near-normal life expectancy for a majority of patients with CF (pwCF) worldwide. Even while addressing disparities in CF care around the world, it is crucial to train medical professionals to suspect and diagnose CF in children as well as in adults. Here, we share our experience of pwCF diagnosed beyond 16 years of age with an aim to highlight the clinical presentations in young adults, the need for screening family members of a newly diagnosed pwCF, and the negative effects of late diagnosis of CF.
囊性纤维化(CF)是一种限制生命的遗传病,具有多系统表现。然而,在表型和基因型上存在巨大差异。这导致了诊断的延误,尤其是胰腺功能不全的患者,他们可能不会表现出典型的症状。近十年来,CF 治疗取得了重大突破。这与通过新生儿筛查进行早期诊断和积极的支持性治疗相结合,可为全球大多数 CF 患者(pwCF)提供接近正常的预期寿命。在解决全球 CF 护理不均衡问题的同时,培训医疗专业人员如何怀疑和诊断儿童及成人 CF 也至关重要。在此,我们与大家分享 16 岁以后确诊的 pwCF 患者的经验,旨在强调年轻成人的临床表现、筛查新确诊 pwCF 患者家庭成员的必要性以及 CF 诊断过晚的负面影响。
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引用次数: 0
Rhythm Generating Mechanisms in Rat Sinoatrial Node 大鼠中房结的节律产生机制
Pub Date : 2024-04-01 DOI: 10.4103/cmi.cmi_124_23
Jesi Charles, Latha Nedumaran, Swetha Raman, Elizabeth Vinod, Rajalakshmi Rajasegaran, Kamalakannan Vadivel, A. Bhaskar, Sathya Subramani
The major membrane currents responsible for sinoatrial (SA) rhythm generation are generally studied in isolated cardiac cells using electrophysiological tools. Such studies are resource and labor-intensive. Here, we have studied four major currents in isolated rat heart preparations, perfused in Langendorff mode, and demonstrate that this is a good preparation for such studies. Heart rates of isolated perfused rat hearts were recorded using surface electrocardiogram before and after perfusion with drugs and solutions that affect the four major currents responsible for SA rhythm generation. The rates of whole isolated hearts beating with SA rhythm decreased with cesium and decreased by about half with ivabradine, both blockers of the funny current (If). Importantly, the rhythm was not abolished even with a high dose of ivabradine at which total blockade of If is expected. The rate was not affected by nickel, a blocker of T-type calcium current. The SA rhythm was abolished by the reduction or removal of sodium from the perfusate (interventions that inhibit the calcium-extrusive mode of the sodium-calcium exchanger) or by nifedipine, the L-type calcium channel blocker. The inferences made based on these observations are (a) If contributes significantly to pacemaking, (b) ICaT does not play a role and (c) INCX and ICaL are obligatory rhythm-generating currents in the SA node. Cyclical calcium release from SR during diastole (the calcium clock), responsible for driving INCX in its forward mode is probably a phenomenon independent of membrane events, as total If blockade did not abolish rhythm generation. These results corroborate with published literature where most studies were done on single cells.
通常使用电生理工具在离体心脏细胞中研究负责产生心房(SA)节律的主要膜电流。此类研究耗费大量资源和人力。 在这里,我们研究了在朗根多夫模式下灌注的离体大鼠心脏制备物中的四种主要电流,并证明这是进行此类研究的良好制备物。在灌注影响 SA 节律产生的四种主要电流的药物和溶液前后,我们使用表面心电图记录了离体灌注大鼠心脏的心率。 使用铯和伊伐布雷定(均为滑稽电流(If)的阻断剂)后,SA 节律跳动的整颗离体心脏的心率降低了一半左右。重要的是,即使使用高剂量的伊伐布雷定(If阻断剂),心律也不会消失。镍是一种 T 型钙电流阻断剂,对心率没有影响。从灌注液中减少或移除钠(抑制钠-钙交换器的钙外渗模式的干预措施)或使用 L 型钙通道阻滞剂硝苯地平,都会取消 SA 节律。 根据这些观察结果得出的推论是:(a) If 对起搏有重要作用;(b) ICaT 没有作用;(c) INCX 和 ICaL 是 SA 节点中产生节律的强制性电流。舒张期 SR 周期性释放钙离子(钙离子时钟)以正向模式驱动 INCX,这可能是一种独立于膜事件的现象,因为完全阻断 If 并不能抑制节律的产生。这些结果与已发表的文献相吻合,其中大多数研究是在单细胞上完成的。
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引用次数: 0
A 6-year Retrospective Study on the Clinical Profile and Outcomes of Postrenal Transplant Patients in the Emergency Department 关于急诊科肾移植术后患者临床概况和疗效的六年回顾性研究
Pub Date : 2024-04-01 DOI: 10.4103/cmi.cmi_167_23
Rashid Tariq Rashid Alshamsi, D. Hazra, A. Al-Alawi
Kidney transplantation is widely recognized as the primary treatment for those with end-stage renal disease. Our goal was to provide an overview of the clinical characteristics of postrenal transplant patients (commercial vs. noncommercial) seeking care in the emergency department (ED). The study was conducted at a leading Omani ED from 2015 to 2021; this study included all postrenal transplant patients. Various variables were categorized, coded, and analyzed. A total of 55 postrenal transplant patients were included in our study. Of these, 60.0% were male (n = 33). Among the participants, 14.5% (n = 8) had undergone noncommercial renal transplants, whereas the remaining 85.5% (n = 47) had undergone commercial renal transplants. Among noncommercial postrenal transplant patients, the most common reasons for ED visits were fever (5), gastrointestinal symptoms (4), and cardiac symptoms (3). They also presented with pain at the surgical site (2) and urological symptoms such as dysuria and hematuria (2). In contrast, the most frequent clinical presentations among commercial postrenal transplant patients were cardiac symptoms (13) and pain at the surgical site (13), followed by fever (12). Noncommercial renal transplant patients had a high discharge rate of 62.5% (5) and a low admission rate of 37.5% (3). On the other hand, commercial renal transplant patients necessitated a high admission rate of 59.6% (28) and a low discharge rate of 40.4% (19). The majority of patients had received commercial kidney transplants, and the most common complaints upon their presentation to the ED were cardiac symptoms and pain at the surgical site. Patients undergoing commercial transplants had higher rates of admission.
肾移植是公认的治疗终末期肾病的主要方法。我们的目标是概述在急诊科(ED)就诊的肾移植术后患者(商业性与非商业性)的临床特征。 这项研究于 2015 年至 2021 年在阿曼一家领先的急诊科进行;研究对象包括所有肾移植术后患者。对各种变量进行了分类、编码和分析。 我们的研究共纳入了 55 名肾移植术后患者。其中,男性占 60.0%(n = 33)。参与者中,14.5%(n = 8)接受过非商业性肾移植,其余 85.5%(n = 47)接受过商业性肾移植。在非商业性肾移植术后患者中,最常见的急诊就诊原因是发烧(5 例)、胃肠道症状(4 例)和心脏症状(3 例)。他们还伴有手术部位疼痛(2)以及排尿困难和血尿等泌尿系统症状(2)。相比之下,商业肾移植术后患者最常见的临床表现是心脏症状(13 例)和手术部位疼痛(13 例),其次是发热(12 例)。非商业性肾移植患者的出院率高达 62.5%(5),入院率低至 37.5%(3)。另一方面,商业肾移植患者的入院率高达 59.6%(28 例),出院率低至 40.4%(19 例)。 大多数患者都接受过商业肾移植手术,他们到急诊室就诊时最常见的主诉是心脏症状和手术部位疼痛。接受商业肾移植的患者入院率较高。
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引用次数: 0
Compound Odontome Causing Agenesis of Mandibular Canine 导致下颌犬发育不全的复合咬合畸形
Pub Date : 2024-04-01 DOI: 10.4103/cmi.cmi_5_24
Ashwin K Harekal, S. Buch
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引用次数: 0
Prevalence of Depression, Anxiety, and Stress along with Coping Strategy and Work-related Sense of Coherence in Anesthesia Care Providers during the COVID-19 Pandemic in a Tertiary Care Hospital: A Cross-sectional Study 一家三级医院的麻醉护理人员在 COVID-19 大流行期间的抑郁、焦虑和压力流行率、应对策略以及与工作相关的连贯感:横断面研究
Pub Date : 2024-04-01 DOI: 10.4103/cmi.cmi_4_24
Meghna Jiwanmall, Jerry Joseph Joel, Aparna Williams, S. Jiwanmall, Bharath Kumar, Ekta Rai
Numerous studies have reported the prevalence of psychological issues in anesthesia professionals during stressful situations like the COVID-19 pandemic; however, there are limited data exploring the coping strategies and work satisfaction in this workforce during the pandemic. In this observational cross-sectional study, three validated questionnaires, namely, the Depression, Anxiety and Stress Scale 21, the Brief-Coping Orientation to Problems Experienced inventory, and the Work-related Sense of Coherence (Work-SoC) scale, were handed out to 150 anesthesia health-care providers (doctors and allied health staff [AHS]). The prevalence of depression, anxiety, and stress; Work-SoC conditions; and coping strategies were compared between groups of participants based on age (<30 years vs. ≥30 years), gender (males vs. females), and occupation (doctors vs. AHS). Participants aged <30 years reported more depression (P = 0.0134) and stress (P = 0.0453) compared to participants aged ≥30 years. Younger participants used emotion-focused and avoidant coping styles, whereas older participants used coping styles that were emotion focused and problem focused. Similarly, a problem-focused coping style was observed frequently among both doctors and AHS. Work-SoC assessment showed that younger participants (P = 0.0088) and more AHS respondents (P = 0.000) attributed poor meaningfulness, but doctors reported poor comprehensibility (P = 0.058) to their working conditions. Younger professionals were more susceptible to stress and depression during the pandemic. Similar to AHS, they perceived work conditions as unrewarding and less meaningful. Doctors perceived working conditions as unmanageable, unpredictable, and unstructured. There were age-related differences in coping strategies where older adults engaged in more proactive coping.
许多研究报告了麻醉专业人员在 COVID-19 大流行等压力情况下普遍存在的心理问题;然而,探索大流行期间麻醉专业人员的应对策略和工作满意度的数据却很有限。 在这项观察性横断面研究中,我们向 150 名麻醉医护人员(医生和专职医护人员 [AHS])发放了三份经过验证的问卷,即抑郁、焦虑和压力量表 21、简明问题应对取向量表和工作相关连贯感量表(Work-SoC)。根据年龄(<30 岁 vs. ≥30 岁)、性别(男性 vs. 女性)和职业(医生 vs. AHS),比较了不同组别参与者的抑郁、焦虑和压力发生率、工作相关连贯性(Work-SoC)状况和应对策略。 与年龄≥30 岁的参与者相比,年龄<30 岁的参与者报告了更多的抑郁(P = 0.0134)和压力(P = 0.0453)。年龄较小的参与者采用以情绪为中心的应对方式和回避型应对方式,而年龄较大的参与者则采用以情绪为中心的应对方式和以问题为中心的应对方式。同样,在医生和助理医疗服务人员中也经常观察到以问题为中心的应对方式。工作意义和可理解性评估显示,年轻的参与者(P = 0.0088)和更多的 AHS 受访者(P = 0.000)认为工作意义差,但医生则认为工作可理解性差(P = 0.058)。 年轻的专业人员在大流行期间更容易受到压力和抑郁的影响。与 AHS 类似,他们认为工作条件没有回报,意义不大。医生认为工作条件难以管理、不可预测和缺乏组织性。在应对策略方面存在着与年龄相关的差异,老年人采取的应对策略更为积极主动。
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引用次数: 0
Health of Tribal Population in India: A Glimpse of the Current Scenario 印度部落人口的健康状况:现状一瞥
Pub Date : 2024-04-01 DOI: 10.4103/cmi.cmi_153_23
Angel Ivy Linda, Debkumar Pal, N. Murmu, Manish Taywade
Article 366(25) of the Indian constitution refers to indigenous people as “scheduled tribes,” which constitute 8.6% of the country’s population. For decades, the health of the tribal people had remained neglected and incorporated in rural health care because of incorrect assumptions of their similar health needs to that of the rural population. An expert committee coordinating with the Ministry of Health and Family Welfare and the Ministry of Tribal Affairs provided a detailed report on the current scenario and recommendations related to tribal health in India. They considered the health-care needs of the tribal population, highlighted their specific health problems, and gave a roadmap of best approaches. The tribal population has a unique and higher burden of health problems than the mainstream population, influenced by their health-seeking behavior, lack of awareness and education, sociocultural and magico-religious beliefs, customs, and practices. The current health-care system incorporates their health needs with approaches such as differing population norms in tribal areas, nonmonetary incentives to staff, mobile medical units, identification of high-priority districts, and the emergence of the “Swasthya” portal. However, tribal health is transitioning as with the rest of the population. Moreover, the present health-care services are unable to address this. Legal recognition of indigenous peoples’ rights to self-determination, their land, natural resources, and their knowledge is a need of the hour.
印度宪法第 366(25)条将土著人称为 "在册部落",占全国人口的 8.6%。几十年来,部落人民的健康问题一直被忽视,并被纳入农村医疗保健,因为人们错误地认为他们的健康需求与农村人口相似。一个与印度卫生和家庭福利部及部落事务部协调的专家委员会提供了一份详细报告,介绍了印度部落健康的现状并提出了相关建议。他们考虑了部落人口的保健需求,强调了他们的具体健康问题,并给出了最佳方法路线图。与主流人口相比,部落人口的健康问题具有独特性且负担更重,这是受其寻求健康的行为、缺乏认识和教育、社会文化和魔法宗教信仰、习俗和惯例的影响。目前的医疗保健系统将他们的健康需求纳入其中,采取的方法包括部落地区不同的人口规范、对工作人员的非货币奖励、流动医疗单位、确定高度优先地区以及 "Swasthya "门户网站的出现。然而,与其他人口一样,部落卫生也在转型。此外,目前的保健服务也无法解决这一问题。从法律上承认原住民的自决权、土地权、自然资源权和知识权是当务之急。
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引用次数: 0
Transitioning from Contrast-induced Nephropathy and Contrast-associated Nephropathy to Contrast-associated Acute Kidney Injury 从造影剂诱发肾病和造影剂相关肾病过渡到造影剂相关急性肾损伤
Pub Date : 2024-04-01 DOI: 10.4103/cmi.cmi_7_24
D. Hazra, Edwin Stephen
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引用次数: 0
Should Medicine be Taught in Leading Medical Languages or the Mother Tongue? 医学应该用主要医学语言还是母语教授?
Pub Date : 2024-04-01 DOI: 10.4103/cmi.cmi_123_23
Abdullah Ashraf Hamad, B. Amer
In non-English speaking developing countries, several debates have arisen over choosing the language of instruction in medical education, whether it should be one of the leading medical languages, such as English, or the mother tongue. In this article, we discuss this debate and provide a brief review of the pedagogical evidence supporting the superiority of the mother tongue as a language of instruction. We also highlight the academic challenges associated with second-language-based medical education and emphasize the impact of language of instruction on the doctor–patient relationship and health care. Finally, we examine the reasons or arguments for not including the mother tongue in medical education. In conclusion, the importance of English as a leading scientific and medical language should not overshadow the crucial role of the native language as the language of instruction in non-English speaking countries. Each country should develop strategies to include the mother tongue in medical education, following the example of developed countries.
在非英语发展中国家,关于选择医学教育的教学语言,是选择英语等主要医学语言之一,还是选择母语,出现了一些争论。在本文中,我们将讨论这一争论,并简要回顾支持母语作为教学语言优越性的教学证据。我们还强调了与以第二语言为基础的医学教育相关的学术挑战,并强调了教学语言对医患关系和医疗保健的影响。最后,我们探讨了不将母语纳入医学教育的原因或理由。总之,在非英语国家,英语作为主要科学和医学语言的重要性不应掩盖母语作为教学语言的关键作用。每个国家都应效仿发达国家,制定将母语纳入医学教育的战略。
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引用次数: 0
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Current medical issues
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