Nevin Manimala

Magn Reson Med. 2023 Jan 3. doi: 10.1002/mrm.29576. Online ahead of print.

ABSTRACT

PURPOSE: To increase the effectiveness of respiratory gating in radial stack-of-stars MRI, particularly when imaging at high spatial resolutions or with multiple echoes.

METHODS: Free induction decay (FID) navigators were integrated into a three-dimensional gradient echo radial stack-of-stars pulse sequence. These navigators provided a motion signal with a high temporal resolution, which allowed single-spoke binning (SSB): each spoke at each phase encode step was sorted individually to the corresponding motion state of the respiratory signal. SSB was compared with spoke-angle binning (SAB), in which all phase encode steps of one projection angle were sorted without the use of additional navigator data. To illustrate the benefit of SSB over SAB, images of a motion phantom and of six free-breathing volunteers were reconstructed after motion-gating using either method. Image sharpness was quantitatively compared using image gradient entropies.

RESULTS: The proposed method resulted in sharper images of the motion phantom and free-breathing volunteers. Differences in gradient entropy were statistically significant (p = 0.03) in favor of SSB. The increased accuracy of motion-gating led to a decrease of streaking artifacts in motion-gated four-dimensional reconstructions. To consistently estimate respiratory signals from the FID-navigator data, specific types of gradient spoiler waveforms were required.

CONCLUSION: SSB allowed high-resolution motion-corrected MR imaging, even when acquiring multiple gradient echo signals or large acquisition matrices, without sacrificing accuracy of motion-gating. SSB thus relieves restrictions on the choice of pulse sequence parameters, enabling the use of motion-gated radial stack-of-stars MRI in a broader domain of clinical applications.

PMID:36594436 | DOI:10.1002/mrm.29576

J Geriatr Psychiatry Neurol. 2023 Jan 3:8919887221149142. doi: 10.1177/08919887221149142. Online ahead of print.

ABSTRACT

INTRODUCTION: Older adults have one of the highest age-specific suicide rates in France, and the risk of suicide is higher for those living in nursing homes. The aim of our study was to assess the effectiveness of gatekeeper training for nursing home staff on the knowledge and stigmas towards suicidal crisis and the impact on suicidal behaviour rates.

METHOD: A total of 427 nursing or administrative staff from 110 nursing homes received gatekeeper training in the Hauts-de-France French region between September 2016 and June 2018. First, knowledge and stigmas on suicidal crisis were assessed through a pretest and posttest survey. Second, a retrospective survey was conducted to determine suicide behaviour rates before and after training in nursing homes. Then, changes between pre- and posttraining scores and suicide rates were evaluated with a paired samples T test and rate difference calculation (P value of <0.05 was considered statistically significant).

RESULTS: A total of 315 trainees completed the questionnaires on knowledge and stigmas related to suicidal crisis, and we found a significant difference in the total scores (P < 0.01). Moreover, we found a significant decrease in the incidence of suicide attempts (SAs) after training (P = 0.002), but the incidence of deaths by suicide was not significantly different prior to and after the training course (P = 0.46).

CONCLUSION: We highlighted an improvement in knowledge and stigmas after training and a reduction in the rates of SAs with our gatekeeper suicide prevention program. Future research is needed to improve suicide prevention for nursing home residents.

PMID:36594410 | DOI:10.1177/08919887221149142

Ann Med. 2023 Dec;55(1):285-291. doi: 10.1080/07853890.2022.2160491.

ABSTRACT

BACKGROUND: The exhaustive information about non-communicable diseases associated with COVID-19 and severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) are getting easier to find in the literature. However, there is a lack of knowledge regarding tuberculosis (TB) and chronic obstructed pulmonary disease (COPD), with numerous infections in COVID-19 patients.

OBJECTIVES: Priority is placed on determining the patient’s prognosis based on the presence or absence of TB and COPD. Additionally, a comparison is made between the risk of death and the likelihood of recovery in terms of time in COVID-19 patients who have either COPD or TB.

METHODOLOGY: At the DHQ Hospital in Muzaffargarh, Punjab, Pakistan, 498 COVID-19 patients with TB and COPD were studied retrospectively. The duration of study started in February 2022 and concluded in August 2022. The Kaplan-Meier curves described time-to-death and time-to-recovery stratified by TB and COPD status. The Wilcoxon test compared the survival rates of people with TB and COPD in two matched paired groups and their status differences with their standard of living.

RESULTS: The risk of death in COVID-19 patients with TB was 1.476 times higher than in those without (95% CI: 0.949-2.295). The recovery risk in COVID-19 patients with TB was 0.677 times lower than in those without (95% CI: 0.436-1.054). Similarly, patients with TB had a significantly shorter time to death (p=.001) and longer time to recovery (p=.001).

CONCLUSIONS: According to the findings, the most significant contributor to an increased risk of morbidity and mortality in TB and COPD patients was the COVID-19.KEY MESSAGESSARS-Cov-19 is a new challenge for the universe in terms of prevention and treatment for people with tuberculosis and chronic obstructive pulmonary disease, among other diseases.Propensity score matching to control for potential biases.Compared to hospitalized patients with and without (TB and COPD) had an equivalently higher mortality rate.

PMID:36594409 | DOI:10.1080/07853890.2022.2160491

Int J Urol. 2023 Jan 3. doi: 10.1111/iju.15138. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the relation between serum zinc concentration and several factors, including serum testosterone concentration and the score of questionnaires on sexual function in patients with sexual problems.

METHODS: This study comprised 720 men (age, 46.3 [21-83] years) with some kind of sexual problem. Age, scores of the Sexual Health Inventory for Men and the Erection Hardness Score, and endocrinologic data including serum concentrations of testosterone, prostate-specific antigen, and zinc were included in this study. After serum zinc concentration of the men was classified into 5 groups (<70, 70≤ <80, 80≤ <90, 90≤ <100, ≤100 μg/dl), the relation of each parameter with serum zinc concentration was assessed for a trend analysis. Finally, the relation between serum concentrations of zinc and testosterone as well sexual function evaluated by the scores of the questionnaires was investigated.

RESULTS: Only serum testosterone concentration (ptrend = 0.028) and serum cortisol concentration (ptrend = 0.003) showed a statistically significant relation to serum zinc concentration by trend analysis. Interestingly, trend analysis between serum concentrations of testosterone and zinc still showed a significant association after adjustment for serum cortisol concentration (ptrend = 0.032). However, no significant association was found in the relation between serum zinc concentration and the scores of the questionnaires after adjustment for serum concentrations of testosterone and cortisol.

CONCLUSION: We clearly showed that after adjustment for serum cortisol concentration by trend analysis, serum testosterone concentration decreased as serum zinc concentration decreased, although sexual symptoms were not associated with this decrease.

PMID:36594398 | DOI:10.1111/iju.15138

Mymensingh Med J. 2023 Jan;32(1):236-239.

ABSTRACT

The success of an endodontic therapy is combinational, dependent on mechanical preparation of canal and chemically detriment of microbial load. Therefore the use of an efficient irrigant is necessary having potential for eradicating the population dependent endodontic microbes. The main aim of the study was to evaluate and compare the antimicrobial potential of commonly used endodontic irrigants and LED light activated curcumin against the endodontic microbial variants of Saudi Arabian population. The 170 infected pulp samples were collected in nutrient broth and streaked on four types of agar plates for each sample after 24 hours of incubation at 37°C. Later after incubation for one day, the microbes were identified under the microscope and the number of microbial colonies. Using well method anti-microbial efficacy of three experimental groups with traditional endodontic irrigants (5.25% NaOCl, 2.0% CHX and 17.0% EDTA), LED light activated photosensitizer and one negative control (NaCl) was evaluated. The photosensitizer and 17.0% EDTA displayed to have efficient anti-microbial potential against E. fecalis and Streptococcal species reducing the colony count and increased radius of 4.3mm (Curcumin)/ 4.1mm (17.0% EDTA) and 3.2mm (Curcumin)/ 3.0mm (17.0% EDTA) showing anti-bacterial effect on the agar plates trailed by 5.25% NaOCl but statistically no significant difference was observed. On contrary 5.25% NaOCl showed strong potential against Staphylococcus and C. albicans species. Overall it can be concluded from the results 5.25% of NaOCl have stronger anti-microbial potential than 17.0% EDTA, CHX and NaCl against endodontic species of Saudi Arabian population.

PMID:36594326

Mymensingh Med J. 2023 Jan;32(1):177-184.

ABSTRACT

To assess the role of the Glasgow Comma Score (GCS) for predicting the outcome of the patient with fever and altered sensorium was the objective of the study. This prospective observational study was conducted for six months following ethical approval. Informed consent was obtained prior enrollment. A total of 50 patients with complaints of fever for <2 weeks duration with altered sensorium with or without seizure were included in the study. GCS was calculated for all patients just after admission and before starting interventions. All patients were investigated and managed according to the hospital protocol. The outcome of the patients (living or dead within the hospital) was evaluated against the admission GCS score. The study was performed in accordance with the current Declaration of Helsinki. Of all, 42.0% (n=21) of the patients had bacterial meningitis, followed by viral encephalitis, cerebral malaria and coma vigil. Complete recovery occurred in 60.0% of cases, while recovery with disability occurred in 28.0% of cases. Death occurred in 12.0% of cases (n=6) due to cerebral malaria, viral encephalitis and bacterial meningitis (n=2 each cause). A higher number of deaths occurred in the lower GCS group (n=5 in GCS group 3-5) and this difference was statistically significant (p<0.05). Moreover, considering death as an outcome, multivariate logistic regression showed that GCS (OR 70.598, 95% CI-1.243-4009.41; p=0.039) was an independent predictor of the outcome. GCS seemed to be a predictor of the short-term outcome of the patient presenting with fever and altered sensorium in our setting. However, further exploration in larger setting with appropriate study design is recommended.

PMID:36594318

Mymensingh Med J. 2023 Jan;32(1):168-176.

ABSTRACT

Uterine fibroids are benign tumor of the uterus that often appear during child bearing ages. Medical treatments are considered the first-line treatment to preserve fertility, avoid or delaying surgery. This randomized control study was carried out in OPD of Obstetrics and Gynecology Department of BSMMU, Dhaka, Bangladesh from May 2018 to March 2019 to evaluate the efficacy and safety of ulipristal acetate (5mg) once daily in reproductive women with three months treatment courses. Total 52 samples with symptomatic uterine fibroids for treatment course-1, among them 36 were needed for treatment course-2 which was slow or non-responding in treatment course-1. Main outcome measures were amenorrhea, controlled bleeding, fibroid volume, anaemia, quality of life. Sixty one percent (61.0%) of patients were achieved amenorrheic during both treatment courses. Ninety percent (90.0%) patients were control of bleeding during both treatment courses. In treatment course-1, reductions from baseline in fibroid volume were 62.70%, whereas in course-2, reductions in fibroid volume were 75.33%. Five percent (5.0%) of patients were discontinuing Ulipristal acetate due to adverse effects. Renal and liver function tests were performed before and after each course of treatment. The level of creatinine, SGPT in the blood for both treatment courses had no statistically significant effects. Ulipristal acetate may be an alternative to surgical treatment, the safety profiles and prolong effects with improvement of symptoms, quality of life after cessation of drugs. Repeated use of drugs reduces the size and also improves the patient’s condition.

PMID:36594317

Mymensingh Med J. 2023 Jan;32(1):90-95.

ABSTRACT

Control of pain in patients with chronic pancreatitis is difficult because 30.0% to 50.0% of patients still experience persistence or recurrence of pain even after surgery. So a combined approach of surgery and coeliac plexus neurolysis was carried out in this study to see the relief of pain and reduce the requirement of analgesics in these patients. This prospective observational comparative study was carried out in the Department of Hepatobiliary, Pancreatic and Liver Transplant Surgery in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from November 2017 to October 2018. Forty one (41) study participants with the diagnosis of chronic pancreatitis were included consecutively in this study. The participants were divided into two groups. Group I (n=18) underwent pancreatic surgery with coeliac plexus neurolysis by infiltration of 20ml of 100% alcohol in the loose areolar tissue 10ml each into right and left para-aortic space at the level of coeliac trunk and Group II (n=23) underwent pancreatic surgery only. Participants’ preoperative data were collected from patient record file. Number, frequency and intensity of pain and requirement of amount of analgesics for the last 3 months were recorded from patients’ history. The intensity of pain was categorized by visual analog scale (VAS) preoperatively. The participants of both groups were followed up at 1, 2 and 3 months interval and asked for disappearance or reduction of pain, frequency of attack and requirement of analgesics. Again visual analog scale was used for categorization of pain. Pain free period was recorded after the end of follow up period. Pain reduction occurred after surgery in both groups. But when pain relief was compared on the basis of VAS (Visual Analogue Scale), it was significantly better in Group I after 1 month of surgery than Group II (p=0.05). But 2 and 3 months after surgery this difference became insignificant (p=0.246 and 0.264). No statistical difference was found in terms of analgesic usage, severe acute attack or hospital admission (p=0.511, 0.439 and 0.495) at the end of 3 months follow up. Participants in Group I had significantly longer pain free period than Group II (p=0.025). Regarding complications, postural hypotension developed in 5.6% (1) patients. Diarrhea developed in 11.1% (2) patients in Group I and wound infection developed in 2 patients in each groups respectively. No patients developed any major complications like anastomotic leakage, deep or organ or space infection. Intraoperative coeliac plexus neurolysis reduces pain immediately after surgery and provides longer pain free period in patients with chronic pancreatitis after surgery.

PMID:36594307

Mymensingh Med J. 2023 Jan;32(1):65-72.

ABSTRACT

Acute myocardial infarction (AMI) patients characterize a large proportion of admissions in coronary care unit and their management and risk stratification is of immense importance. Hypomagnesemia is a long-term risk factor for incident of both myocardial infarction and arrhythmia. We assessed whether serum magnesium levels at admission is associated with arrhythmias and in-hospital mortality in patients with acute myocardial infarction (AMI). The aim of the study was to evaluate the prognostic implications of serum magnesium level in patients with acute myocardial infarction. This cross-sectional observational study was conducted in the department of cardiology in Mymensingh Medical College Hospital from October 2017 to March 2019. Total 259 acute myocardial infarction patients were included considering inclusion and exclusion criteria. The sample population was divided into two groups: Group-I: Patients with acute myocardial infarction with serum magnesium ≥1.82mg/dl. Group-II: Patients with acute myocardial infarction with serum magnesium <1.82mg/dl. Serum magnesium level was measured on admission, and the incidence of in-hospital major cardiac events was assessed. In this study mean serum magnesium level of Group-I, Group-II were 2.21±0.14mg/dl, 1.60±0.15mg/dl respectively. It was statistically significant (p<0.05). In-hospital outcomes of the study group revealed that low risk group patients were uneventful outcome during hospitalization period, they had no any complication. In Group-I patient, 9(4.8%) were developed arrhythmias, 26(13.9%) were developed heart failure, 9(4.8%) were developed cardiogenic shock and 3(1.6%) were died and in Group-II patient, 44(61.10%) developed arrhythmias, 9(12.50%) were developed heart failure, 7(9.7%) were developed cardiogenic shock and 12(16.7%) were died out of them which was statistically significant (p<0.05). Mean duration of hospital stay of the study population according serum magnesium level was in Group-I, 4.27±0.68 days, in Group-II, 5.84±1.05 days which was statistically significant (p<0.05). In conclusion patient with serum magnesium level less than 1.82mg/dl increased the risk of in-hospital arrhythmia and death.

PMID:36594303

Mymensingh Med J. 2023 Jan;32(1):61-64.

ABSTRACT

Sedentary lifestyle are spreading worldwide because of lack of available spaces for exercise, increased occupational sedentary behaviors such as office work and the increased prevalence of television and video devices. Increased incidence of sedentary lifestyle and obesity in developed and developing countries is one of the major risk factors for the development of cardiovascular diseases. This study was undertaken to analyze the differences in anthropometric and cardiovascular parameters in sedentary and non-sedentary male subjects. This analytical type of cross sectional study was carried out in the Department of Physiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2021 to June 2022. This study consisted 50 male employees of 25-60 years who worked in an office were study group (Group II) and control group Group-I) consisted of 50 male age matched physical laborers. BMI was calculated as weight in kilogram divided by the height in meter square i.e. kg/m². Blood Pressure was measured by indirect auscultatory method with an aneroid sphygmomanometer. Statistical analysis was done by using Student’s un-paired ‘t’ test. Values expressed as mean ± standard deviation. P value was taken as significant at 5 percent confidence level. The mean±SD BMI in kg/m² of Group I and Group II were 21.90±2.22 and 29.32±3.13 respectively. The mean±SD systolic blood pressure of Group I and Group II were 112.20±6.79 and 145.10±8.11 and mean±SD diastolic blood pressure of Group I and Group II were 72.80±5.73 and 91.00±5.05 respectively. The BMI and blood pressure were increased in sedentary group compared to non-sedentary group. From the study, it appears that the risk for cardiovascular disease is increased in sedentary workers.

PMID:36594302