International Archives of Integrated Medicine

5-13

Authors: Aijaz Ahmad Hakeem, Irshad Mohiuddin, Tanvir Iqbal

The incidence of prostate cancer has been gradually increasing in the world. Checking the serum prostate-specific antigen (PSA) level and a digital rectal examination (DRE) are the gold standards for prostate cancer screening. Prostate gland is divided into four zones, the peripheral zone (PZ), transitional zone and central zone and anterior nonglandular fibromuscular stroma. Prostate is divided into minimum 16 and optionally 27 regions of interest as per European consensus meeting. Until recently, most professionals have been skeptical that magnetic resonance imaging (MRI) could be used on a widespread basis to diagnose or stage prostate cancer with any degree of reliability, and therefore help with making treatment decisions. The aim of the present study was to study diagnostic value of mpMRI of prostate in cases of raised PSA but with negative biopsy. The present study was carried out in the post graduate department of Radiodiagnosis and imaging Govt. Medical College Srinagar over a period of one year from May 2016 to April 2017. All patients with negative prostatic biopsy were evaluated on Siemens 3 tesla MRI scanner. All patients underwent initial T1W scanning to look for any evidence of hemorrhage and patients having hemorrhage due to previous biopsy were also excluded from study or their study was deferred until hemorrhagic artifacts disappear. After proper case selection patients were subjected to detail Multiparametric MRI (mpMRI) for prostate 6-8 weeks period was given from previous biopsy time to MRI study and cases with hemorrhage on T1 weighted sequence were either excluded from study or their study was deferred till resolution of haemorrhage. The conclusion of the present study was that Mp-MRI prior to repeat biopsies can improve the detection rate of clinically significant PCa and allow for a more accuracy in prostate disease diagnosis.

20-26

Authors: Rabindranath Eswaran, Premkumar Karunakaran, Allwin James, Venkateswaran Arcot Rajeswaran, Rajkumar Solomon

Introduction: Periampullary diverticula (PAD) are mucosal outpouchings commonly situated on the medial aspect of second part of duodenum; usually within 2-3 cm of the ampulla of vater. PAD are usually asymptomatic incidental findings during side viewing scopy. We aimed to analyze the influence of PAD in the management of patients who underwent ERCP during past 6 years in our centre. Materials and methods: Patients between the ages of 13 and 74 with the diagnosis of pancreaticobiliary diseases who underwent ERCP at Institute of medical gastroenterology, Madras Medical College from January 2012 to December 2017 were taken into account for retrospective analysis. We assessed and compared ERCP results in patients with and without PAD. Results: A total of 3412 patients underwent ERCP that of these 197(5.77%) patients had PAD. Among the 3412 cases , the incidences of PAD in patients age group less than 50 years was 2.6% and age group more than 50 years was 8.1%(P<0.001). Successful biliary cannulation was achieved in 79.18% (n=156) of patients with PAD and 93.1% of patients of patients without PAD (P<0.001). Of that in patients with PAD, for 28.93 %( n=57) cases underwent precut needle papillotomy. The papilla was undetectable in 6 cases with PAD. Incidence of PAD was higher in choledocholithiasis group (9.2% vs 4.1%, p=0.003), but in incidence of CBD stricture had no difference. Complete clearance of CBD stones was achieved lesser in patients with PAD (72.4% vs 86.8% P=0.02). Conclusion: The frequency of PAD increases with age and occurs more in choledocholithiasis cases. Our experience showed decreased rate of cannulation success with PAD, increased difficulty in cannulation and decreased rate of successful stone retrieval.

38-43

Authors: Mallapu Gangadhara Reddy, P. Sivaramakrishna

Background: Pulmonary hypertension (PH) is an uncommon cause for chest pain in patients without significant coronary artery disease (CAD). Therefore, we studied the association between chest pain, right ventricular dimensions (RVDs), and PA size on coronary coronary tomographic angiography (CCTA). Materials and methods: It was a prospective study done from the February 1, 2015 to August 31, 2015. Total of 98 patients were identified, 67 in the chest pain and 31 in the non-chest pain group. Results: Patients with chest pain without CAD showed markedly dilated right atrial and ventricular chambers compared with standard parameters. PAD was measured as 24.81± 0.47 mm in the chest pain group and 21.91 ± 0.41 mm in the control group (P < 0.05). Odds ratio between chest pain and a significantly higher PAD was 10.11 (2.76-41.91, P < .05), 10.33 (2.15-61.41, P < .05) after adjusting for age, sex, BMI, history of HTN, HLP, CHF, COPD, OSA, and smoking. The chest pain group had an RAD1 of 47.19± 0.61 mm, RAD2 of 43.83 ± 1.79 mm, RVD1 of 37.91± 0.75 mm, RVD2 of 30.87± 0.73 mm, and RVD3 of 60.31± 1.1 mm. Based on the existing echocardiographic reference ranges, these measures fall within the upper limits of normal range. When comparing chest pain vs non-chest pain group, respectively, the mean RAD2 measured 39.98 ± 0.73 mm vs 33.78± 1.13 mm (P = .005), and the mean RVD2 measured 30.87± 0.73 mm vs 26.71± 1.73 (P = .03). Conclusion: In patients presenting with chest pain without CAD on CCTA, there is a strong association between the presence of chest pain and enlarged PAD.

52-54

Authors: Sanjay Verma, Nupur Suman, Piyoosh Verma

The purpose of this research was to determine the effect of electronic gadgets on cognitive milestones of children below 2 years of age. While conducting the research methods used were, 100 children of age group 6 months - 2 years were taken and divided in 2 groups - group 1 included 25 children of normal milestones up to 2 years. Group 2 included 75 children who attained normal milestones according to their age and then they were introduced with electronic gadgets (mostly mobile /play games) at different age. For minimum of 4-5 hours a day. Children were followed up at 2 months interval up to 2 years. The result of the study showed, Group 1 children attained normal milestones – physical as well as cognitive up to 2 years of age; While Group 2 children who were introduced electronic gadgets, 63 children attained normal physical milestones as well as cognitive milestones, but 12 of them had developed delayed cognitive milestones with normal physical milestones. Out of these 12 children, 5 of them had more impact of electronic gadgets i.e. they had shown delayed or regression of cognitive milestones. Overall the research concluded that, Electronic gadgets do affect the cognitive milestones of children from 6 months onwards.

61-71

Authors: Archana Tangudu, B. Badari Ramakrishna, K.V.S.P. Gupta, M.V. Mrudula, Rahul Marshal Vaddeswarapu

The immune system evolved to protect multicellular organisms from pathogens. It defends the body against invaders, and generates an enormous variety of cells and molecules capable of specifically recognizing and eliminating foreign invaders, all of which act together in a dynamic network. Neutrophils have been referred to as a first line of defense, meaning that they are first defensive cells to be recruited to a site of inflammation; however the resident leukocytes are cells which normally exist at the sites of inflammation. Neutrophils exhibit their antibacterial action with the help of granules or by virtue of its ability to reduce dioxygen to hydrogen peroxide. The primary mission of neutrophils is to find bacteria and neutralize them by phagocytosis.

77-82

Authors: G. Sunil, I. Ranganayakulu, R.S.V.M. Raghu Ram, Pathapati Srinivas Raju

Corticotomy assisted orthodontic treatment is a time-honored and effective orthodontic procedure that progressively extended admiration as an adjunct treatment preference for adults. It involves selective alveolar decortication in the form of lines and dots performed around the tooth that are to be moved. It is done to induce a state of increased tissue turnover and a transient osteopenia, which is followed by a faster rate of orthodontic tooth movement. The treatment time is reduced to one-third of that in conventional orthodontics. Its main advantages are reduction of treatment time and post orthodontic stability. The aim of this article is to present a broad review on the corticotomy assisted orthodontic treatment in adults.