Abstract:

Typhoid fever is a major public health problem globally; the greater burden however occurs in the developing countries because of lack of potable water and proper waste management. The disease is associated with a high mortality rate especially in those with enteric perforation or intestinal hemorrhage. The goal of this study was to identify the clinical and laboratory factors that predict the development of enteric perforation in children with typhoid fever.

This study was a retrospective case control analysis of children admitted for typhoid fever without or without enteric perforation over a three year period in a newly established teaching hospital in Kannur. Forty seven children with typhoid fever and enteric perforation (cases) were compared with 94 controls (those without typhoid fever but without enteric perforation). Multivariate analysis using logistic regression was applied to all the factors that were initially significantly associated with enteric perforation. Male sex (Odd Ratio, OR=3.10, p=0.003); inadequate treatment (OR=3.03,P< 0.001); short duration of illness (OR=2.36,P=0.030); neutrophilia (OR=2.92,p=0.013) and elevated ESR (OR=1.07, P=0.041) were found to have independently contributed to development of perforation in children with typhoid fever. This study has attempted to outline the factors that may predict typhoid ideal perforation in children, thereby helping in recognition of high risk cases and drawing up of screening tool to facilitate effective and prompt management.

References:

[1.] Adesunkanmi, A., R., Ajao, O., G (1997) .The Prognostic Factors in Typhoid Ileal Perforation; A Prospective Study of 50 Patients. JR Coll Surg Edinb, 42, 395-399.

[2.] Ameh, E., A.Typhoid Ileal Perforation in Children; A Scourge in developing countries. Ann Trop Paediatr, 19(3), 267-272.

[3.] Butler, T., Knight, J., Nath, S., K., Speelman, P., Roy, S., K, Azad, M., A (1985). Typhoid Fever Complicated by Intestinal Perforation: A Persisting Fatal Disease Requiring Surgical Management. Rev Infect Dis, 7(2), 244-256.

[4.] Chao, H., C., Chiu, C., H., Kong, M., S. , Chang, L., Y., Huang, Y., C., L in TY, e..t al (2000). Factors Associated with Intestinal Perforation in Children’s Non-typhi Salmonella Toxic Megacolon. Pediatr Infect Dis J, 19, 1158-1162.

[5.] Everest, P., Wain, J., Roberts, M., Rock, G., Duogon, G (2001). The Molecular Mechanism of Severe Typhoid Fever. Trend Microbiol, 9(7), 316-320.

[6.] Hosoglu, S., Aldemir, M., Akalin, S., Geyik, M., F., Tacyildiz, I., H., and Leob, M (2004). Risk Factors For Enteric Perforation in Patients with Typhoid Fever. Am J Epidemiol, 160(1), 46-50.

[7.] Khan, M., Coovadia, Y., M., Connolly, C., Sturm, A., W(1999). Influence of Gender on Clinical Features, Laboratory Findings, and Complications of Typhoid Fever. Am J Trop Med Hyg, 61(1), 41-46.

[8.] Meier, D., E., Tarpley, J., L (1998). Typhoid Intestinal Perforation in Children. World J Surg, 22(3), 319-323.

[9.] Mock, C., N., Amaral, J., Visser, L., E (1992). Improvement In Survival from Typhoid Ileal Perforation: Results of 221 Operative Cases. Ann Surg,;215(3), 244-249.

[10.]   Ogunlesi, T., Runsewe-Abiodun, I., Olanrewa, D(2010) . Health Care Seeking Behaviour For Childhood Illness in a Resource Poor Setting. J Paediatr Child Health, 46, 238-242 doi:10.111/j.1440-1754.2009.01677.x.

[11.]   Row, B., Ward, L., R(1990). Threl-Fall EJ. Spread of Multiresistant Salmonella Typhi. Lancet, 334, 1065.

[12.]   Thomas, B(2000). Typhoid Fever. In; Goldman L, Bennet JC, Editors. Cecil Text Book of Medicine Vol.2 (21st edition).USA:WB Saunders, 1681-1683.

[13.]   Van der Zee, H (2008) .Media For the Isolation of Salmonella.In: Corry JEL, Curtis GDW, Baird RM Editors. Handbook of culture media for Microbiology. Oxford, UK: Elsevvier, 34, 195-446.

[14.]   World Health Organisation (2008). Typhoid vaccines: World Health Organisation position paper. Weekly Epidemiol Rec, 83(6), 49-60.

[15.]   Yap, F., Y., Puthucheary, S., D. Typhoid Fever in Children. A Retrospective Study of 54 Cases from Malaysia. Singapore Med J, 39(6), 260-262.

Abstract:

Intravenous immunoglobulin (IVIG) is used in various autoimmune disorders and is the agent of choice in the management of Guillain Barre Syndrome. Review of literature shows association of viral and bacterial infections with the use of IVIG and in this paper we describe a case of fungal septicemia that occurred after treatment with IVIG.  

References:

[1.] Gold, R., Stangel, M., Dalakas, M. C. Drugs insight: the use of intravenous immunoglobulin in neurology-therapeutic considerations and practical issues. Nat Clin Pract Neurol. 2007; 3: 36-44.

[2.] Intravenous immunoglobulin: prevention and treatment of disease. NIH consensus development conference statement, May 21-23, 1990. Vol.8, No.5 Bethesda Md: Office of Medical Applications of Research, National Institutes of Health, 1990.

[3.] Kazatchkine, M. D., Kaveri, S.V. Immunomodulation of autoimmune and inflammatory diseases with intravenous immune globulin. N Engl J Med. 2001; 345: 747-55

[4.] Kondo, N., Ozawa, T., Mushiake, K., Motoyoshi, F., Kameyama, T., Kasahara, K. et al. Suppression of immunoglobulin production of lymphocytes by intravenous immunoglobulin. J Clin Immunol. 1991; 11: 152-8.

[5.] Mackay, I. R., and Rosen, F. S. Immunomodulation of autoimmune and inflammatory diseases with intravenous immune globulin. N Engl J Med. 2001; 345(10): 747-55.

[6.] Maddur, M. S, Othy, S., Hegde, P., Vani, J., Lacroix-Desmazes, S., Bayry, J et al. Immunomodulation by intravenous immunoglobulin: Role of Regulatory T Cells. J Clin Immunol 2010; 30: S4-S8.

[7.] Naranjo, C. A., Busto, U., Sellers, E.M, Sandor, P., Ruiz, I., Roberts E. A. et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981; 30: 239-45.

[8.] Nimmerjahn, F., Ravetch, J. V. Anti-inflammatory actions of intravenous immunoglobulin. Annu Rev Immuno, 2008; 26: 513-33

[9.] Traynor, T. R., Huffnagle, G. B. Role of chemokines in fungal infections. Med. Mycol. 2001; 39: 41-50

[10.]   Wijesundere, A. Guillain-Barre syndrome in plasmodium falciparum malaria. Postgrad Med J. 1992; 68: 376-77

Abstract:

In 1976, Parks, Gordon and Hardcastle published their article entitled ‘A classification of Fistula- in ano.’ Their classification was based on the identification of four types of fistula: inter sphincteric, trans sphincteric, supra sphincteric and extra sphincteric. An intersphincteric fistula runs downwards between the internal and external sphincters. The trans sphincteric fistula runs from the intersphincteric space, through the external anal sphincter into the ischiorectal space. The supra sphincteric fistula runs upward between the internal sphincter and external sphincter and then bends around the pubo rectalis muscle and penetrates the pelvic floor, to traverse downwards through the ischiorectal fossa.

An extra sphincteric fistula passes through the external anal sphincter and then branches out into two tracks- one extending cephalad penetrating the pelvic floor and finally ending in rectum and the other extending caudally ending in the external opening. Although this classification does not take into account the circumferential extend of the disease it is widely used because of its simplicity. Another reason is that this classification relates the anatomical relation of the fistulous track to the anal sphincters which is relevant for the choice of treatment.  

References:

[1.] Beets-Tan, R., G., Beets, G., L., van der Hoop, A., G., et al (2001). Preoperative MR imaging of anal fistulae: does it really help the surgeon? Radiology, 218, 75–84.

[2.] Buchanan, G., Halligan, S., Williams, A., et al (2002). Effect of MRI on clinical outcome of recurrent fistula-in-ano. Lancet, 360, 1661–1662.

[3.] Domkundwar, S., V., Shingare, A., B. Role of transcutaneous perianal ultrasonography in evaluation of fistula in ano. J.Ultrasound in medicine, 26, 29-36.

[4.] Fishman-Javitt, M., C., Lovecchio, J., L., Javors, B., Naidich, J., B, McKinley, M., Stein, H., L. (1987). The value of MRI in evaluating perirectal and pelvic disease. Magn Reson Imaging, 5, 371–380.

[5.] Frudinger, A., Bartrum, C., I., Halligan, S. ,Kamm, M., A. (1998). Examination techniques for anal endosonography. Abdominal imaging, 23, 301-303.

[6.] Goodsall, D., H., Miles, W., E. Diseases of the anus and rectum. London, England:Longmans,Green.

[7.] Halligan, S., Stoker, J. (2006), Imaging of Fistula in ano. Radiolog, 239, 18-33.

[8.] Kuijpers, H., C., Sculpen, T. (1985). Fistulography for fistula in ano; is it useful? Dis Colon Rectum, 28, 103-104.

[9.] Koelbel, G., Schmiedl, U., Majer, M., C., et al (1989). Diagnosis of fistulae and sinus tracts in patients with Crohn disease: value of MR imaging. AJR Am J Roentgenol, 152, 999–1003.

[10.]   Law, P., J., Bartram, C., I. (1989). Anal endosonography: technique and normal anatomy. Gastrointestinal Radiology, 14, 349-535.

[11.]   Lunniss, P., J., Armstrong, P., Barker, P., G., et al (1992). Magnetic resonance imaging of anal fistulae. Lancet, 340, 394–396.

[12.]   Madsen, S., M., Myschetzky, P., S., Heldmann, U., Rasmussen, O., O, Thomsen, H., S. (1999). Fistula in ano: evaluation with low-field magnetic resonance imaging (0.1 T). Scand J Gastroenterology, 34, 1253–1256.

[13.]   Mallouhi, A., Bonatti, H., Peer, S., Lugger, P., Conrad, F., Bodner, G. (2004). Detection and characterization of perianal inflammatory disease: accuracy of transperineal combined gray scale and color Doppler sonography. J Ultrasound Med, 23, 19–27.

[14.]   Milligan, E., T., Morgan, C., N. (1934). Surgical anatomy of the anal canal with special reference to anorectal fistulae. Lancet, 2, 1213-1217.

[15.]   Parks, A., G., Gordon, P., H., Hardcastle, J., D. (1976). A Classification of fistula in ano. British Journal of surgery, 63, 1-12.

[16.]   Platell, C., Mackay, J., Collopy, B., Fink, R., Ryan, P., Woods, R. (1996). Anal pathology in patients with Crohn's disease. Aust N Z J Surg, 66, 5–9.

[17.]   Scratter-Sehn, A., U., Lochs, H., Vogelsang, H., Scurawitzki, H., Herold, C., Scratter, M. (1993). Endoscopic ultrasonography versus computed tomography in the differential diagnosis of perianorectal complications in Crohn’s disease. Endoscopy, 25, 582-586.

[18.]   Spencer, J., A., Chapple, K., Wilson, D., Ward, J., Windsor, A., C., Ambrose, N. (1998). Outcome after surgery for perianal fistula: predictive value of MR imaging. AJR Am J Roentgenol, 171, 403–406.

[19.]   Stewart, L., K., McGee, J., Wilson, S., R. (2001). Transperineal and transvaginal sonography of perianal inflammatory disease. AJR Am J Roentgenol, 177, 627–632.

[20.]   Sultan, A., H., Kamm, M., A., Hudson, C., N., Thomas, J, Bartram, C., I. (1993). Anal sphincter disruption during vaginal delivery. New England Journal of Medicine, 329, 1905-1911.

[21.]   Schwartz, D., A., Wiersema, M., J., Dudiack, K., M, etal (2001). A comparison of endoscopic ultrasound,magnetic resonance imaging and examination under anaesthesia for evaluation of Crohn’s perianal fistulae. Gastroenterology, 121, 1064-1072.

[22.]   Taylor, S., A., Halligan, S., Bartram. C., I. (2003). Pilonidal sinus disease: MR imaging distinction from fistula in ano. Radiology, 226, 662–667.

[23.]   Weisman, R., I., Orsay, C., P., Pearl, R., Ketal (1991). The role of fistulography in fistula in ano:report of five cases. Dis Colon Rectum, 34, 181-184.

[24.]   Winter, A., M, Hanauer, S., B. (1998). Medical management of perianal Crohn's disease. Semin Gastrointest Dis, 9, 10–14

Abstract:

Under the influence of physical loads on the body of athletes there occurs an adaptation in accordance with the thrust of the training process. A particular focus of the training process changes and specializes as the morphology and function of the body of an athlete changes. There are peculiarities in the adaptation of an athlete's cardio-vascular system to the specific type of sport activity. Taking into account these peculiarities, one can estimate the intracardiac sizes of the athletes of various sports specializations. The quantitative values of the echocardiographic parameters in athletes of different kinds, establishes the presence of changes in the geometry of the left ventricle of the heart of athletes with various orientations of the training process.

References:

[1.] Agadjanjan, M. G. (2001). Athletic heart with the position of evaluating the degree of left ventricular hypertrophy. Human physiology, 27, 125–128.

[2.] Bulychev, V., Khmelevsky, V., Rutman, J. (2011). To the question of myocardial hypertrophy in the athletes body. Clinical medicine, 3, 108–112.

[3.] Gavrilova, H. (2009). The modern representations about the athlete’s heart. Informational-analytical bulletin of the Belarusian State University of Physical Culture, 1, 25–29.

[4.] Marushko, J., Gihjak, T., Kozlovskij, V. (2008). Cardiovascular status in the athletes body (the athlete’s heart). Sport medicine, 2, 21–42.

[5.] Smolenskij, A. (2010). The topical issues of the sports cardiology. Medical bulletin, 12, 21–26.

[6.] Solodkov, A., Talibov, A., Marchenko, S. (2007). The features of remodeling and functioning of the left ventricle of the athlete’s heart. The theory and practice of physical culture, 1, 6–9.

Abstract:

Testis is the superficial structure and scrotum has thin skin and subcutaneous tissue. This makes the evaluation of the testis by ultrasound very accurate and effective. However, high frequency to be used for evaluation of such structures to get best resolution. This article was mainly describing the role of the high frequency ultrasound for testicular trauma. This can find out and depict very nicely even the minute quantity of fluid (less than 1cc) .It can pick a tiny lesion as small as 2-3mm.Hence any traumatic rupture, hemorrhage, collection ,contusion, parecnhymal changes can be diagnosed with 100% accuracy. The use of doppler along with the imaging increases its sensitivity, particularly in finding out the infarctions and mass lesions. Ultrasound not only has role in diagnosis, but also helps in management of such cases to evaluate the response of the treatment

References:

[1.] Adigun, I., A., Kuranga, S., A., Abdulrahman, L., O (2002). Grinding Machine: Friend or Foe. West Afr J Med, 21, 338–340.

[2.] Altarac, S. Management of 53 Cases of Testicular Trauma (1994). Eur Urol, 25, 119–123.

[3.] Bhatt, S., Dogra, V., S (2007). Utility Of High Frequency Transducer Sonography in Scrotal Trauma. Presented at the annual meeting of the American Institute of Ultrasound in Medicine, New York, NY, March 15–18.

[4.] Bhatt, S., Ghazale, H., Dogra, V., S (2007). Sonographic Evaluation of Scrotal And Penile Trauma. Ultrasound Clin, 2, 45–56.

[5.] Blaivas, M., Brannam, L( 2004). Testicular Ultrasound. Emerg Med Clin North Am 22, 723–748.

[6.] Bedir, S., Yildirim, I., Sumer, F., Tahmaz, L., Dayanc, M., Peker, A., F (2005). Testicular Dislocation As A Delayed Presentation of Scrotal Trauma. J Trauma, 58, 404–405.

[7.] Bromberg, W., Wong, C., Kurek, S., Salim, A (2003). Traumatic Bilateral Testicular Dislocation. J Trauma, 54, 1009–1011.

[8.] Buckley, J., C., McAninch, J., W (2006). Use Of Ultrasonography For The Diagnosis of Testicular Injuries In Blunt Scrotal Trauma. J Urol , 175, 175–178.

[9.] Cass, A., S., Ferrara, L., Wolpert, J., Lee, J (1988). Bilateral Testicular Injury From External Trauma. J Urol, 140, 1435–1436.

[10.]   Cass, A., S., Luxenberg, M (1991). Testicular Injuries. Urology, 37 , 528–530.

[11.]   Corrales, J., G., Corbel, L., Cipolla, B., et al (1993). Accuracy of Ultrasound Diagnosis After Blunt Testicular Trauma. J Urol, 150 , 1834–1836.

[12.]   Cohen, H., L., Shapiro, M., L., Haller, J., O., Glassberg, K (1992). Sonography of Intrascrotal Hematomas Simulating Testicular Rupture in Adolescents. Pediatr Radiol, 22, 296–297.

[13.]   Deurdulian, C., Mittelstaedt, C., A., Chong, W., K., Fielding, J., R ( 2007). US of Acute Scrotal Trauma: Optimal Technique, Imaging Findings, And Management. Radio-Graphics, 27, 357–369.

[14.]   Dogra, V., S, Gottlieb, R., H, Oka, M., Rubens, D., J (2003). Sonography of the Scrotum. Radiology, 227, 18–36.

[15.]   Dogra, V., Bhatt, S. Acute Painful Scrotum (2004). Radiol Clin North Am, 42, 349–363.

[16.]   Guichard, G., El Ammari, J., Del Coro, C., et al. (2008). Accuracy of Ultrasonography in Diagnosis of Testicular Rupture After Blunt Scrotal Trauma. Urology, 71, 52–56.

[17.]   Hayami, S., Ishigooka, M., Suzuki, Y., Sasagawa, I., Nakada, T., Mitobe, K (1996). Pathological Changes Of Traumatic Dislocated Test Is. Urol Int, 56, 129–132.

[18.]   Haas, C., A., Brown, S., L., Spirnak, J., P (1999). Penile Fracture And Testicular Rupture. World J Urol 17, 101–106.

[19.]   Ihama, Y., Fuke, C., Miyazaki, T (2007). A Two-Rider Motorcycle Accident Involving Injuries Around Groin Area in Both the Driver and The Passenger. Leg Med (Tokyo), 9, 274–277.

[20.]   Jeffrey, R., B., Laing, F., C., Hricak, H., McAninch, J., W. Sonography of Testicular Trauma (1983). AJR Am J Roentgenol 141, 993–995.

[21.]   Kratzik, C., Hainz, A., Kuber, W., et al (1989). Has Ultrasound Influenced The Therapy Concept of Blunt Scrotaltrauma? J Urol, 142, 1243–1246.

[22.]   Lupetin, A., R., King, W., 3rd, Rich, P., J., Lederman, R., B (1983). The Traumatized Scrotum: Ultrasound Evaluation. Radiology, 148, 203–207.

[23.]   Lee, J., Y., Cass, A., S., Streitz, J., M (1992). Traumatic Dislocation of Testes And Bladder Rupture. Urology, 40, 506–508.

[24.]   Lujan, Marco, S., Budia, Alba, A., Bango, Garcia, V., Ramirez, Backhaus, M., Delgado, Oliva, F., J., Jimenez, Cruz, J., F (2006). Traumatic Testicular Dislocation [in Spanish]. Actas Urol Esp, 30, 409–411.

[25.]   Micallef, M., Ahmad, I., Ramesh, N., Hurley, M., McInerney, D (2001). Ultrasound Features of Blunt Testicular Injury. Injury, 32, 23–26.

[26.]   Mulhall, J., P., Gabram, S., G., Jacobs, L., M (1995). Emergency Management of Blunt Testicular Trauma. Acad Emerg Med, 2, 639–643.

[27.]   Muttarak, M., Thinyu, S., Lojanapiwat, B (2007). Clinics In Diagnostic Imaging (114): Rupture of the Right Testis. Singapore Med J, 48, 264–268.

[28.]   Pepe, P., Panella, P., Pennisi, M., Aragona, F (2006). Does Color Doppler Sonography Improve the Clinical Assessment of Patients With Acute Scrotum? Eur J Radiol, 60, 120–124.

[29.]   Ragheb, D., Higgins, J., L. (2002). Jr. Ultrasonography of The Scrotum: Technique, Anatomy, And Pathologic Entities. J Ultrasound Med, 2002 (21), 171–185.

[30.]   Ridgway PF, Shah J, Darzi AW (2002). Male genital tract injuries after contemporary inguinal hernia repair. BJU Int, 90, 272–276.

[31.]   Schwartz, S., L., Faerber, G., J (1994). Dislocation Of The Testis As a Delayed Presentation of Scrotal Trauma. Urology, 43, 743–745.

[32.]   Taylor, E., W., Duffy, K., Lee, K., et al (2004). Surgical Site Infection After Groin Hernia Repair. Br Surg, 91, 105–111.

[33.]   Wessells, H., Long, L (2006) . Penile And Genital Injuries. Urol Clin North Am, 33, 117–126.

Abstract:

Reducing high blood cholesterol, a risk factor for cardiovascular disease (CVD) in people with and without a past history of CVD is an important goal of pharmacotherapy. Statins are the first-choice agents. Previous reviews of the effects of statins have highlighted their benefits in people with CVD. The case for primary prevention was uncertain when the last version of this review was published (2011) and in light of new data an update of this review is required.

References:

[1.] Hasnia Ziar, Philippe Gérard, Ali Riazi, (2014). Effect of prebiotic carbohydrates on growth, bile survival and cholesterol uptake abilities of dairy-related bacteria. Journal of the Science of Food and Agriculture, 94, 2

[2.] Jacquelyn, A., Quin, Brack Hattler, Muath Bishawi, Janet Baltz, Sandeep Gupta, Joseph, F., Collins, Frederick, L., Grover, Gerald McDonald, A., Laurie, W., Shroyer (2013). Impact of Lipid-Lowering Medications and Low-Density Lipoprotein Levels on 1-Year Clinical Outcomes after Coronary Artery Bypass Grafting. Journal of the American College of Surgeons, 217, 3, 452

[3.] Jane Stock (2013). HDL function and cardiovascular risk: Debate continues. Atherosclerosis, 229, 1, 38

[4.] Jonathan Chrispin, Seth, S., Martin, Rani, K., Hasan, Parag, H., Joshi, C., Michael Minder, John, W., McEvoy, Payal Kohli, Amber, E., Johnson, Libin Wang, Michael, J., Blaha, Roger, S., Blumenthal(2013). Landmark Lipid-Lowering Trials in the Primary Prevention of Cardiovascular Disease. Clinical Cardiology, 36, 9

[5.] Jennifer, G., Robinson (2013). Statins vs Early Hormone Therapy for the Primary Prevention of Cardiovascular Disease in Women. Current Cardiovascular Risk Reports, 7, 3, 163

[6.] S., Halimi (2013). Cholestérol-Statines, la polémique crée le trouble !. Médecine des Maladies Métaboliques, 7, 5, 397

[7.] Süleyman Bilecen, Joris, A., H., Groot, Cor, J., Kalkman, Alexander, J., Spanjersberg, Karel, G., M., Moons, Arno, P., Nierich (2013). Effectiveness of a cardiac surgery–specific transfusion protocol. Transfusion , 53, 11 pt2

[8.] Sougat Ray, A., K., Jindal, S., Sengupta, S., Sinha (2013). Statins: Can we advocate them for primary prevention of heart disease?. Medical Journal Armed Forces India.

Abstract:

This review, reviews the article` Association of umbilical coiling index by colour doppler ultrasonography at 18-22wks of gestation and perinatal outcome’. This review will initially summarize the article. Then it is intended to analyse the article structure and find out the methods of investigation and whether the informations are clearly evident to the reader. Finally, the review will critically analyse the article and evaluate its authority, accuracy, updation , objectivity and coverage. The review will analyse the images, the tables before judging the articles accessibility and credibility. The article to be reviewed has been written very clearly and is clinically very relevant and innovative.

References:

[1.] Blickstein, I., Varon, Y., Varon, E (2001). Implications of differences in coiling indices at different segments of the umbilical cord. Gynecol Obstet Invest, 52, 203–206.

[2.] Cromi, A., Ghezzi, F., Di Naro, E. , Siesto, G., Bergamini, V., Raio, L (2007). Large cross-sectional area of the umbilical cord as a predictor of fetal macrosomia. Ultrasound Obstet Gynecol, 30: 861–866.

[3.] Cromi, A., Ghezzi, F., Durig, P., Di Naro, E., Raio, L (2005). Sonographic umbilical cord morphometry and coiling patterns in twin-twin transfusion syndrome. Prenat Diagn, 25: 851–855.

[4.] Dado, G. M., Dobrin, P. B., Mrkvicka, R. S (1997). Venous flow through coiled and noncoiled umbilical cords. Effects of external compression, twisting and longitudinal stretching. J Reprod Med, 42, 576–580.

[5.] Degani, S., Leibovich, Z., Shapiro, I., Gonen, R., Ohel, G (2001). Early second-trimester low umbilical coiling index predicts smallforgestational-age fetuses. J Ultrasound Med , 20, 1183–1188.

[6.] Degani, S., Lewinsky, R. M., Berger, H., Spiegel, D (1995). Sonographic estimation of umbilical coiling index and correlation with Doppler flow characteristics. Obstet Gynecol, 86, 990–993.

[7.] De Laat, M. W., Franx, A., Bots, M. L., Visser, G. H., Nikkels, P. G (2006). Umbilical coiling index in normal and complicated pregnancies. Obstet Gynecol, 107, 1049–1055.

[8.] De Laat, M. W., Franx, A., Nikkels, P.G., Visser, G. H (2006). Prenatal ultrasonographic prediction of the umbilical coiling index at birth and adverse pregnancy outcome. Ultrasound Obstet Gynecol; 28, 704–709.

[9.] De Laat, M. W., van Alderen, E. D., Franx, A., Visser, G. H., Bots, M. L., Nikkels, P . G (2007). The umbilical coiling index in complicated pregnancy. Eur J Obstet Gynecol Reprod Biol, 130,66–72.

[10.]   De Laat, M. W., Nikkels, P. G., Franx, A., Visser, G. H (2007). The Roach muscle bundle and umbilical cord coiling. Early Hum Dev, 83, 571–574.

[11.]   Ercal, T., Lacin, S., Altunyurt, S., Saygili, U., Cinar, O., Mumcu, A (1996).Umbilical coiling index: is it a marker for the foetus at risk? Br J Clin Pract, 50, 254–256.

[12.]   Ezimokhai, M., Rizk, D.E., Thomas, L (2000). Maternal risk factors for abnormal vascular coiling of the umbilical cord. Am J Perinatol, 17, 441–445.

[13.]   Garber, A., Hernandez, L., Mullin, C., Simon, M (2004). Pressure Flow Through a Coiled Tube, Group M5, BE 310 Spring, http://www.seas.upenn.edu/courses/belab/LabProjects/2004/ be310s04m5.doc [Accessed 23 August 2007].

[14.]   Georgiou, H. M., Rice, G. E., Walker, S.P., Wein, P., Gude, N. M., Permezel, M (2001). The effect of vascular coiling on venous perfusion during experimental umbilical cord encirclement. Am J Obstet Gynecol, 184, 673–678.

[15.]   Kashanian, M., Akbarian, A., Kouhpayehzadeh, J (2006). The umbilical coiling index and adverse perinatal outcome. Int J Gynaecol Obstet, 95, 8–13.

[16.]   Machin, G. A., Ackerman, J., Gilbert-Barness, E (2000) . Abnormal umbilical cord coiling is associated with adverse perinatal outcomes. Pediatr Dev Pathol, 3, 462–471.

[17.]   Otsubo, Y., Yoneyama, Y., Suzuki, S., Sawa, R., Araki, T (1999). Sonographic evaluation of umbilical cord insertion with umbilical coiling index. J Clin Ultrasound, 27, 341–344.

[18.]   Predanic, M., Perni, S. C., Chasen, S.T., Baergen, R.N., Chervenak, F.A (2005). Assessment of umbilical cord coiling during the routine fetal sonographic anatomic survey in the second trimester. J Ultrasound Med, 24, 185–191.

[19.]   Predanic, M., Perni, S. C., Chasen, S. T., Baergen, R. N., Chervenak, F. A (2005). Ultrasound evaluation of abnormal umbilical cord coiling in second trimester of gestation in association with adverse pregnancy outcome. AmJObstetGynecol, 193, 387–394.

[20.]   Predanic, M., Perni, S. C., Chervenak, F. A (2006). Antenatal umbilical coiling index and Doppler flow characteristics. Ultrasound Obstet Gynecol, 28, 699–703.

[21.]   Qin, Y., Lau, T. K., Rogers, M. S (2002). Second-trimester ultrasonographic assessment of the umbilical coiling index. Ultrasound Obstet Gynecol, 20, 458–463.

[22.]   Rana, J., Ebert, G. A., Kappy, K.A (1995). Adverse perinatal outcome in patients with an abnormal umbilical coiling index. Obstet Gynecol, 85, 573–577.

[23.]   Singh, V., Khanum, S., Singh, M (2003). Umbilical cord lesions in early intrauterine fetal demise. Arch Pathol Lab Med, 127, 850–853.

[24.]   Strong, T.H., Jr, Manriquez-Gilpin, M. P., Gilpin, B. G (1996). Umbilical vascular coiling and nuchal entanglement. J Matern Fetal Med, 5, 359–361.

[25.]   Strong, T.H., Jarles, D. L., Vega, J. S., Feldman, D. B (1994). The umbilical coiling index. Am J Obstet Gynecol , 170, 29–32.

[26.]   Van, Diik, C .C., Franx, A., de Laat, M. W., Bruinse, H. W., Visser, G. H., Nikkels, P. G (2002). The umbilical coiling index in normal pregnancy. J Matern Fetal Neonatal Med, 11, 280–283.

Abstract:

Appendicitis is one of the commonest causes of emergency department visits. Though it is a common pathology and has classical clinical features, yet it often presents atypically. In such cases, the diagnosis is a dilemma especially as there are many close mimics and these are the cases where imaging helps and ultrasound often is the first to be undertaken. However ultrasound is largely operator dependent and frequently provides false negative result. These may be overcome to a large extent by following a systematic methodology of looking for the pathology. Based on a review of the articles a basic picture especially for beginners is presented here.

References:

[1.] Fox, J. C., Solley, M., Anderson, C. L., et al (2008). Prospective evaluation of emergency physician performed bedside ultrasound to detect acute appendicitis. Eur. J. Emerg. Med,;15(2),80-5.

[2.] Han, T. I (2002). Sonographic visualization of the appendix with a saline enema. J. Ultrasound Med, 21, 511-6.

[3.] Han, T.I (2002). Improved Sonographic Visualization of the Appendix With a Saline Enema in Children With Suspected Appendicitis. J Ultrasound Med, 21,511–516.

[4.] Jeffrey, R. B., Jain, K. A., Nghiem, H. V(1994). Sonographic diagnosis of acute appendicitis: interpretive pitfalls. Am. J. Radiol.;162:55-9.

[5.] Lee, J. H., Jeong, Y. K., Park, K. B., Park, J. K., Jeong, A. K., Hwang, J. C (2005). Operator-dependent techniques for Graded Compression Sonography to Detect the appendix and Diagnose Acute Appendicitis. American Journal of Roentgenology,184, 91-97.

[6.] Old, J. L., Dusing, R. W., Yap, W., Dirks, J (2005). Imaging for Suspected Appendicitis. Am Fam Physician, 71(1):71-78.

[7.] Rioux, M (1992). Sonographic detection of the normal and abnormal appendix. Am. J. Roentgenol, 158, 773-8.

[8.] Sharma, M., Agrawal, A(2008). Pictorial essay: CT scan of appendicitis and its mimics causing right lower quadrant pain. Indian J Radiol Imaging, 18(1), 80–89.

[9.] Shin, L. K., Jeffrey, R. B (2010). Sonography and computed tomography of the mimics of appendicitis. Ultrasound Q,26(4),201-10.

[10.]   Tauro, L. F., Premanand, T. S., Aithala, P. S., George C., Suresh, H. B., Acharya, D., John, P(2009). Ultrasonography Is Still A Useful Diagnostic Tool In Acute Appendicitis. Journal of Clinical and Diagnostic Research, 3, 1731-1736.

[11.]   Trout, A. T., Sanchez, R., Ladino-Torres, M. F., Pai, D. R., Strouse, P. J(2012). A critical evaluation of US for the diagnosis of pediatric acute appendicitis in a real-life setting: how can we improve the diagnostic value of sonography? Pediatr Radiol, 42(7), 813-23.

[12.]   Vriesman, A. V. B., Puylaert, J. B (2006). Mimics of Appendicitis: Alternative Non surgical Diagnoses with sonography and CT. Am Jo of Roentgenol, 186,1103-1111.

Abstract:

Tuberculosis is the most common communicable disease world wide. In this era of immune-compromising disease like acquired immune deficiency syndrome, is necessary to have knowledge of the different presenting features of various rare manifestation of tuberculosis. Young individuals are more prone to such lesion because lack of immunity, close grouping with infected patients and the general increased chances of varying presentation in such patients. This study groups together rare presentation of extrapulmonary tuberculosis of the head and neck region in an effort to increase the recognition of this disease.

References:

[1.] Abbot, J. N., Briney, A. T. and Denam, S. A (1995). Recovery of tubercle bacilli from mouth washings of tuberculous dental patients. Am Dent Assoc, 50, 49-52

[2.] Adeel, A., Butt, M.B (1997). Nasal tuberculosis in the 20th century. Am J Med Sci,, 313(6);332-335

[3.] Alwarez, S., Mc Cabe, W (1984).Extra pulmonary tuberculosis revisited:a review of experience at Boston City and other hospitals. Medicine(Balt), 63(1)25-55

[4.] Batra, K., Chaudhary, N., Motwani, G., Rai, A. K (2002). An unusual case of primary nasal tuberculosis with epistaxis and epilepsy. Ear Nose Throat J, 81(12);842-844

[5.] Brennan, T. F. , Vrabec, D. P (1970).Tuberculosis of the oral mucosa report of a case. Ann Oto Rhinol Laryngol, 80, 601-605

[6.] Brodsky, R. H., Klattel, J. S (1943).The tuberculosis of dental periapical granulomas. Am Orthod Oral Sung, 29, 498-502

[7.] Cantrell, R. W., Jensen, J. H., Reid, D (1975).Diagnosis and management of tuberculous cervical adenitis. Arch Otolaryngol, 101, 53-57.

[8.] Chapotel(1993).Tuberculose mandibulaire.Rev Odontol, 5, 444-454

[9.] Eng, H. L., Lu, S. Y., Yang, C. H., Chen, W.J (1996). Oral tuberculosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod , 81(4), 415-20

[10.]   Fujimoto, T., Morishima, T., Ueda, M (1996).Probable BCG Osteomylitis of the hard palate; a case report. Int J Oral Maxilofac Surg, (2),145-146

[11.]   Junquera Gutierrez, L. M., Alonso Vaquero, D., Albertos Castro, J. M., Palacios Gutierrez. J. J., Vicente Rodriguez, J. C (1996).Primary tuberculosis of the oral cavity. Rev Stomatol Chir Maxilofac, 97(1),3-6

[12.]   Kanlikama, M.,Mumbuc, S., Bayazit, Y., Sirikci, A (2000).Management strategy of mycobacterial cervical lymphadenitis. J Laryngol Otol,114(4), 274-278.

[13.]   Kobayashi, T., Sato, M., Onoi, Y., Ohshiro, S., Nishii, K., Ishihira, T et al (1997). A case of pulmonary tuberculosis complicated with gingival lesions. Kekkaku,72(6),411-414

[14.]   Kolokotronis, A., Antoniadis Trigonidis, D., Papanagiotou, G (1996).Oral tuberculosis. Oral Dis,2(3);242-243

[15.]   Lbekwe, A.O., al Sharref, Z., al Kindy, S (1997). Diagnostic problems of tuberculous cervical adenitis (scrofula).Am J Otolaryngol, 18, 202-205.

[16.]   Mann, N. J (1985). Tuberculosis initially diagnosed by asymptomatic oral lesions; report of three cases oral.J Oral Med, 40(1), 39-42

[17.]   Mignogna, M. D., Muzio, L. L., Favia, G.(2006), Ruoppo E, Sammartino G, Zarrelli C et al.Oral tuberculosis ,a clinical evaluation of 42 cases. Oral Dis, 6(1), 25-30

[18.]   Murray, A., Gardiner, D. S., McGuiness, R. J (1996).Primary mycobacterial infection of the uvula. The J Laryngol and Otol(1998). Dhamgaye TM. Nasal tuberculosis. Otolaryngol Head Neck Surg, 114(6), 841-842

[19.]   Nakajima, H (1993). Tuberculosis, a global emergency . World Health Organisation, 46:3

[20.]   Nunn, P., Mugnai, M., Nyamuraya, J., Giecheha, C., Brindle, R. J., Dunn, D. T. et al (1994).The effects of human immunodeficiency virus type 1 on the infectiousness of Tubercle bacilli. Tuber Lung Dis,75(1), 25-32

[21.]   Rohwedder, J.J (1974).Upper respiratory tract tuberculosis. Sixteen cases in general hospital. Ann Intern Med, 80:708-713

[22.]   Sierra, C., Fortun, J., Pais, J., Gomez-Mampaso (1992). E.Tuberculosis del paladar sin afectaction pulmonary. Enf Infec Microbiol Clin,, 10(8), 509-510

[23.]   Shafer, W. G., Hine, M.K. , Levy, B. M (1993).A text book of oral pathology (4^thedition).WB Saunders Company;Philadelphia.

[24.]   Spilka, C. J.(1995)Tuberculosis of the mandible-report of a case oral. Sung Oral Med Oral Pathol,13, 68-70

[25.]   Sloane, M. F (1996).Mycobacterial lymphadenitis. In: Rom WN, Garay SM,(editors).Tuberculosis. Boston/New York/Toronto/London: Little. Brown and Company, pp.577-583

[26.]   S.L., Robbins, Cottan, R. S.(1979) Pathologic basis of disease, Philadelphia. WB Saunders Co, pp.396-397.

[27.]   Toren, A. , Ackerstein, A., Gazit, D., Or, R.,Ravesh, D., Kupolovicz, U et al (1996).Oral tuberculosis following autologous bone marrow transplantation for Hodgkin’s disease with interleukin-2 and alpha interferon immunotherapy. Bone Marrow Transplant, 18(1), 209-210.

[28.]   Thilander, H., Wennstrom, A (1956). Tuberculosis of the mouth and surrounding tissues oral. Surg Oral Med and Oral Pathol, 9, 858-870

[29.]   Weir, M., Thosnton, G (1985). Extrapulmonary tuberculosis. Am J Med, 79, 467-476

[30.]   William, R., Douglas-Jones, T (1995).Mycobacterium marches back. JLaryngol Otol, 109, 5-13

Abstract:

The study set out to assess Primary Health Care in Kosofe Local Government Area of Lagos State : It identified the roles played by Kosofe Local Government in the management of PHC in the area: determined the effects of PHC programmes on the lives of the people and communities in the Local Government Area.: and also, examined the problems militating against successful management of the programme.

Primary data were collected through the use of questionnaire and interview method. Sixty (60) copies questionnaire were administered on both health service providers and health care beneficiaries in the Local Government in order of twenty (20) for the health care providers and forty (40) for the health care beneficiaries .Nineteen(19) respondents were also interviewed: six (6) health care providers-The Community Health Officer (CHO), two (2) Nurses, 1 Health Educator, Health Attendants and a Community Health Extension Workers (CHEW);thirteen (13) from the health care beneficiaries -4 Pregnant Women,4 Nursing Mothers,3 Students and 2 Market Women. Secondary data were sourced from relevant textbooks, internet and journals. The data were analyzed using frequency distribution, tables and simple percentages.

The findings of the study show that Primary Health Care is the major service provided by the Local Government as indicated in the analysis where 65% of the respondents strongly agreed to,86% of respondents also agreed that PHC’s services have effects over their lives positively,58% of the respondents claimed that poor funding is a major problem of PHC etc.

The study concluded that Primary Health Care (PHC) delivery in Kosofe L.G.A is not yet satisfactory.

References:

[1.] Aday, L.A., & Andersen, R.M.(1984).`Exploring Dimensions of Access to Medical Care” . Health Services Research,18,49-74.

[2.] Adeniyi, J., Oladepo ,O. and A.Soyibo.2003."Survey of Primary Health Care Service Delivery in Lagos and Kogi: A Field Report``. Mimeo, African. Regional Health Education Center,University of Ibadan.

[3.] Asuzu, M.C.(2004) ‘‘The necessity for a health systems reform in Nigeria’’. Journal of Community Medicine & Primary Health Care, Vol.16,No.1. June, pp. 1-3.

[4.] Dare O. (2000), ‘‘Linking health and development in Nigeria: The Oriade innovative’’, Ibadan Archives of Medicine, Guest edition.

[5.] Fung C.H., Woo, H.E., Asch S.M., (2004), Controversies and Legal Issues of Prescribing and Dispensing Medications using the Internet. Mayo Clin. Proc, 79(2):188-94.

[6.] Implications for Serving the Elderly``. Journal of Aging Studies,5, 375-389.Gazettes and Official Publications

[7.] Lawler, T.G., & Valand, M.C. (1988). ‘‘Patterns of Practice of Nurse Practitioners in an Underserved Rural Region’’. Journal of Community Health Nursing,5(3),187-194.

[8.] Magilvy, J.K, Congdon, J.G., & Martinez, R.(1994). ‘‘Circles of Care:Home and Community Support for Rural Older Adults’’. Advances in Nursing Science, 16(3), 22-33.

[9.] Miller, T.E., Derse A.R., (2002) ‘‘Between Strangers: The Practice of Medicine Online’’Health Aff. (Millwood); 21(4):168-79.

[10.]   Rowland,D., & Lyons, B. (1989).``Triple Jeopardy: Rural, Poor and Uninsured’’. Health Services Research, 23, 975-1004``.

[11.]   Rowles, G.D.(1991).``Changing Health Culture in Rural Appalachia

[12.]   U.S Library of Congress (2000), ``Nigeria Primary Health Care Policies.Icweb2.Ioc.

[13.]   Unpublished work Federal Republic of Nigeria, Federal Ministry of Health. (1996). ``National Health Policy``. Abuja Nigeria.

[14.]   World Health Organization (1975).`Primary Health Care for all. Monograph No1.

Abstract:

Acute pancreatitis is the inflammation of the pancreatic parenchyma. It can vary from mild to severe form with many simple to dangerous complications. Clinically patient presents with severe abdominal pain in the epigastric region. Vomiting, fever may be present. However it may present with various other types in complicated cases. Ultrsound is not very much useful as the gland visualization is poor and not in its complete entirety, due to its position and bowel gas shadows. CT is the investigation of choice, which shows enlarged hypodense pancreatic parenchyma. Fluid collection in the lesser sac and rertoperitoneum may be seen. The occurrence of the disease is less common in children; more in alcoholics and fatty females.

References:

[1.] Balthazar, E.,J., Freeny, P., C., Van, Sonnenberg, E (1994). Imaging and Intervention in Acute Pancreatitis. Radiology, 193, 297-306.

[2.] Balthazara, E., J., Robinson, D., Megibow, A (1990). Acute pancreatitis: Value of CT In Establishing Prognosis. Radiology, 174, 331-336.

[3.] Berger, H., G., Rau, B., Mayer, J., Pralle, U (1997). Natural Course of Acute Pancreatitis. World J Surgery, 21, 130-5.

[4.] Corfield, A., P., Cooper, M., J., Williamson, R., C., N. Prediction Of Severity in Acute Pancreatitis: Prospective Comparison of Three Prognostic Indices. Lancet, 2, 403-407.

[5.] Fan, S.,T., Choi, T.,K., Lai, E., C., Wong, J. (1988). Acute Pancreatitis In Aged. Australian & New Zealand Journal of Surgery, 58, 717-21.

[6.] Gastano, D., L., H., Antolin, S., Salovnil., D., Pena, D., Garcia, J., Romero, P (1997). Relationship Between The Presenting Symptoms And Age In Diagnosis In Alcoholic And Non-Alcoholic Chronic Pancreatitis. Rev Esp Enferm Dig, 89, 269-79.

[7.] Jeffery, R., B., Jr. Sonography in Acute Pancreatitis (1989). Radiologic Clinics of North America, 27, 5.

[8.] Jeffery, R., B., Jr., Laing, F., C., Wing, V., W (1986). Extrapancreatic spread of acute pancreatitis: New observations with real-time US. Radiology, 159, 707.

[9.] Lawson, T., L (1983). Acute Pancreatitis and Its Complications: Computed Tomography and Sonography. Radiologic Clinics of North America, 21, 495-513.

[10.]   McMahoon, M., J., Playforth, M., J., Pickforth, I., R (1980). A Comparative Study of Methods For The Prediction of Severity of Attack of Acute Pancreatitis. BJS, 67, 22-25.

[11.]   Mitchell, D. MR Imaging Of The Pancreas (1995). MRI Clinics of North America, 3, 51-71.

[12.]   Mortele, K.,J., Mergo, P., J, Taylor, H., M, Ernst, M.,D., Ros, P., R (2000). Renal And Perirenal Space Involvement in Acute Pancreatitis: Spiral CT Findings. Abdominal Imaging, 25, 272-8.

[13.]   Mortele K., J., Mergo, P., J., Taylor, H., M., Ernst, M., D., Ros, P., R. Splenic and Perisplenic (2001). Involvement In Acute Pancreatitis: Determination of Prevalence And Morphologic Helical CT Features. Computer Assisted Tomography, (25), 50-54.

[14.]   Ranson, J.,H.,C., Rifkind, K.,M., Rose, D.,F (1974). Objective Early Identification of Severe Acute Pancreatitis. Am J Gastroenterology, 61, 443-51.

[15.]   Stear, M., L.. (1995). Recent Insights Into The Etiology And Pathogenesis of Acute Biliary Pancreatits. AJR, 164, 811-14.

[16.]   Tenner, S., Fernandez-del Castillo, C., Warshaw, A(1997). Urinary Trypsinogen Activation Peptide (TAP) Predicts Severity in Patients With Acute Pancreatitis. Int J Pancreatol 21, 105-10.

[17.]   Tsushima, Y., Tamura, T., Tomioka, K., Okada, C., Kusano, S., Endo, K. (1999). Transient splenomegaly in acute pancreatitis. BJR, 72, 637-43.