ISSN 1301 - 0883 / E-ISSN 1309 - 3886

  Eastern J Med: 15 (2)
Volume: 15  Issue: 2 - 2010
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1.Evidence based decision making in pediatric practice
Madhumita Nandi, Rakesh Mondal
Pages 43 - 47
Evidence Based Medicine (EBM) is integrating individual clinical expertise with the best available external evidence from systematic research. It has made rapid strides in the last ten years with an increase in the number of EBM centers, books and agencies. The supporters of EBM claim that it is the best and most objective system of medicine. Its opponents criticize it for many reasons referring to EBM as ‘cook-book’ medicine and the fad of epidemiologists etc. Though EBM centers are coming up at a fast rate in the western world, our part of the world has not yet fully aligned with this initiative. The purpose of this communication is to introduce EBM to pediatricians. Provided herein, is a brief introduction followed by brief history, how to incorporate evidence-based practice into the clinical setting and the main criticisms against it.

2.In vivo comparative immunotoxic study of histamine receptors (H1R, H2R, H3R and H4R)-agonist
Trivendra Tripathi, Mohammad Shahid, Adil Raza, Haris M. Khan, Mashiatullah Siddiqui, Abida Malik, Rahat Ali Khan
Pages 48 - 56
Accumulating evidences have highlighted histamine and histamine receptors (HRs)-antagonists’ role in immunomodulation. However, the roles of HRs-agonists are still unclear. The present study was therefore designed to delineate the comparative immunotoxic roles of H1-H4-agonist on antibody generation profile in rabbit model. The cohort comprised of seven groups (Group-I negative control, group-II positive control and group-III-VII HRs-agonist-treated) containing 18 (9 male and 9 female) rabbits each. Group-I and group-II received vehicle (sterile distilled water, 1mlkg-1×b.i.d.) intramuscularly. Groups-III-VII (HRs-agonist-treated) received subcutaneous histamine (100µgkg-1) and H1-agonist (HTMT), H2-agonist (amthamine), H3-agonist (R-[-]-?-methylhistamine) and H4-agonist (clobenpropit) each in a dose of 10µgkg-1, respectively, b.i.d. for 10 days (starting from day 1). Groups-II-VII were subsequently immunized with intravenous injection of SRBC at day 3. The estimation of serum immunoglobulins (Ig), IgM and IgG were done by ELISA, and observed at day 0 (pre-immunization) and day 7, 14, 21, 28 and 58 (post-immunization). Results showed that histamine and HRs-agonist could influence a detectable antibody response to SRBC as early as day 7-postimmunization (post-I), which lasted until day 58- post-I. All the results were found statistically significant (p<0.05). To conclude, our results provide evidences that HTMT, amthamine and clobenpropit (H1-, H2- and H4-agonist, respectively) have important role in modulation of antibody generation by enhancing production level, in which HTMT have dominant role, while amthamine and clobenpropit play similar role. Conversely, R-[-]-?-methylhistamine (H3-agonist) have dominant inhibitory role on antibody production.

3.Etiologic agents and extended-spectrum beta-lactamase production in urinary tract infections in Sanandaj, Iran
Rashid Ramazan zadeh
Pages 57 - 62
Extended-spectrum ß-lactamases has emerged as an important mechanism of resistance in Gram-negative bacteria. In this study, we aimed to determine the frequency of extended spectrum beta lactamase producing isolates in (urinary tract infections). ESBL-production was tested by the double-disc synergy method and more confirmed by PCR amplification. Out of 188 isolated microorganisms Escherichia coli (80%) was the most frequent. Production was determined in 14.5% of clinically gram negative isolates. CTX-M type was the most prevalent type (12.7%) and SHV and TEM type were in the next ranks. Our data indicate the spread of these enzymes in clinically gram negative isolates in urinary tract samples collected from two general hospitals of Sanandaj.

4.Ice pick headache and electrical seizures: a unique clinical entity?
Chandan Raybarman
Pages 63 - 66
Headache is often ignored as a symptom of epileptic seizure. To date, there have been no reports of ice pick headache as a symptom or association in epileptic seizure. Six children (ages 5.5-10 years; average 8.6 years; male-female ratio, 2:1) presenting with ice pick headache and paroxysmal electroencephalographic changes compatible with the diagnosis of epilepsy were evaluated. Only 66.6% had clinical seizures. The antiepileptic drugs were consistently effective in all cases. These findings seem to suggest that a distinct group of symptoms and signs (ice-pick headache, paroxysmal electroencephalographic changes, and epileptic seizure), which, associated together form a characteristic clinical picture or entity. This is the first report, to date. This report highlights the necessity to further search this unique clinical condition.

5.Hypothalamic hamartoma presenting with gelastic seizures and precocious puberty: Report of a case
Feroze Shaheen, Aijaz Hakim, Maqbool Wani, Rauf Asmi
Pages 67 - 70
Hypothalamic hamartoma is a rare condition and usually presents with precocious puberty. Clinical manifestation as gelastic seizures is less common and combined presentation as gelastic seizures and precocious puberty is even less frequent. Being a treatable condition, prompt diagnosis is important. offers precise diagnosis in most cases.

6.Clozapine associated delirium
Raman Baweja, Karim Sedky, Steven Lippmann
Pages 71 - 72
Delirium is an encephalopathy characterized by disorientation, confusion, and short-term memory impairment. It can be caused by a variety of pharmaceuticals that includes clozapine. The etiology in clozapine cases includes anticholinergic effects and a neuroleptic malignant syndrome-like picture. The risk for a clozapine induced delirium is greater at high dosages, during dose increases, and with polypharmacy. Resolution follows clozapine dose reductions and/or medicine discontinuations.

7.Acute abdomen due to intestinal band
Şükrü Özbek, Zeki Mesten, Ali Yılmaz, İsmet Gün
Pages 73 - 75
Acute abdomen is a serious health problem seen at any age, any sex. The causes are several, specially intestinal obstruction are shown as the main cause. Intraabdominal adhesions may also lead to such a problem, it was explained that omental band was thought to be the cause of this about a rate of 3%. In this case a 20 year old female patient, virgin, not having an operation was admitted as acute abdomen. No explanation could be made what the cause was till she had an operation. She had an omental band, which was resected during this operation. Such cases should be mentioned by a multidisciplinary approach like general surgery and gynaecology.

8.Solitary subcutaneous gluteal hydatid cyst: a case report
Majid Mushtaque, Mohammad F. Mir, Manzoor A Lone, Sajjid H Batt
Pages 76 - 79
A 50-year-old female presented with a swelling in the left gluteal region (upper outer region) since two years which was gradually increasing in size. Fine needle aspiration cytology of the swelling was done which was inconclusive. Incisional biopsy of the swelling done at some peripheral hospital revealed hydatid cyst. Based on histopathological examination, ultrasonography and magnetic resonance imaging features along with positive serology diagnosis of solitary gluteal subcutaneous hydatid cyst was made and total cystectomy (cystopericystectomy) was done. Post-operatively patient was put on albendazole. Larval stage of Echinococcus is the cause of hydatid cyst. Four species of Echinococcus tapeworm can produce disease in humans viz E.granulosus and E.multilocularis cause cystic and alveolar hydatid disease respectively, while E.vogeli and E.oligarthus rarely infect humans. Hydatid cyst of subcutaneous tissue is extremely rare, and this case report highlights the rarest location of the hydatid cyst.

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