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SHORT COMMUNICATION
Assessment of nutritional status in the community and clinical settings
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
September-October 2014, 34(5):211-213
DOI:10.4103/1011-4564.143648  
The nutritional status of an individual is usually a result of multiple factors that interact with each other at different levels. Recognizing the role of diet at the onset of many diseases and assessing the nutritional status of an individual, family and community are important for public health. The nutritional assessment is done to obtain information about the prevalence and geographic distribution of nutritional disorders within a community or a specified population group. It can also be used to identify high-risk groups and to assess the role of different epidemiological factors in nutritional deficiency. Assessment of the nutritional status aids assessing the prevalence of nutritional disorders, planning corrective measures, and evaluating the effectiveness of the implemented strategies simultaneously.
  41,320 1,651 -
CASE REPORTS
Pulsed radiofrequency therapy for relieving neuropathic bone pain in cancer patients
Wei-Li Lin, Bo-Feng Lin, Chen-Hwan Cherng, Billy K Huh, Hsin-I Ma, Shinn-Long Lin, Chih-Shung Wong, Chun-Chang Yeh
March-April 2014, 34(2):84-87
DOI:10.4103/1011-4564.131903  
Metastatic bone pain is among the most commonly reported pain conditions in cancer patients and pharmacological therapy frequently fails to provide satisfactory pain relief. Pulsed radiofrequency (PRF) is a minimally invasive procedure and may be an effective alternative. However, there is little published data evaluating PRF treatment of metastatic pain. PRF therapy of select lumbar dorsal root ganglia was performed on two patients suffering from uncontrolled metastatic lumbar bone pain. After PRF therapy, the patients reported markedly improved back pain, and the effect lasted for months until they deceased. No complications or adverse events were noted from this minimally invasive procedure. PRF may be considered a potential intervention in treating certain neuropathic cancer pain conditions.
  11,100 323 3
ORIGINAL ARTICLES
Antimicrobial activities of cefoperazone-sulbactam in comparison to cefoperazone against clinical organisms from medical centers in Taiwan
Tsung-Ta Chiang, Hung-Jen Tang, Cheng-Hsun Chiu, Te-Li Chen, Mao-Wang Ho, Chen-Hsiang Lee, Wang-Huei Sheng, Ya-Sung Yang
November-December 2016, 36(6):229-233
DOI:10.4103/1011-4564.196365  
Background: The multidrug-resistant Gram-negative bacteria (MDRGNBs) have emerged as important pathogens recently. Cefoperazone-sulbactam is active against a great proportion of those MDRGNBs. However, the susceptibilities data of cefoperazone-sulbactam are lacking in Taiwan. Object: This study was conducted to evaluate the susceptibilities data of cefoperazone-sulbactam aganist commonly encountered clinical pathogens in Taiwan. Materials and Methods: 2272 isolates were collected from various clinical specimens from five centers in Taiwan in 2012. The agar dilution method was used to evaluate the susceptibility of the isolated pathogens to cefoperazone and cefoperazone-sulbactam. Result: cefoperazone-sulbactam showed better activity against various GNBs, including MDRGNBs and part of carbapenem-resistant isolates tested compared to cefoperazone alone. Conclusion: Cefoperazone-sulbactam is active against most commonly encountered clinical pathogens, including MDRGNBs and part of carbapenem-esistant A. baumannii complex. It can be a potentially therapeutic agent for treating infections caused by these pathogens in Taiwan.
  10,381 590 2
CASE REPORTS
Frameless stereotactic deep brain stimulation for Parkinson's disease: A case report and technical note
Chun-Chieh Lin, Tung-Han Tsai, Yueh-Feng Sung, Da-Tong Ju, Yung-Hsiao Chiang, Yuan-Hao Chen
September-October 2014, 34(5):224-234
DOI:10.4103/1011-4564.143652  
Because deep brain stimulation (DBS) implantations and other stereotactic and functional surgical procedures require accurate, precise, and safe targeting of the brain structure, the technical aids for preoperative planning, intervention, and postoperative follow-up have become increasingly important. In this paper, we introduce a case of advanced Parkinson's disease with 10 years of medical control in which the patient received subthalamic nuclei (STN) DBS therapy through frameless surgery. A preliminary outcomes analysis is also provided. The STN DBS was implanted using a frameless stereotaxy protocol. After identifying the STN by microelectrode recording (MER), the DBS electrodes were implanted and connected to an implanted programmable generator. Programming started 1 month after the operation, and the patient was followed up on regularly and 12 months of post-STN DBS unified Parkinson's disease rating scale were recorded. After 12 months of follow-up, the patient who received the frameless surgery showed a significant improvement in clinical motor functions compared with his preoperative scores. The frameless system has the advantage of providing accuracy in postoperative lead position survey and target deviation measurements with comparison to the preoperative planning image. The outcomes of frameless DBS surgery are similar to those of frame-based surgery, with the advantages being that frameless surgery can reduce the patient's discomfort, shorten the operation and MER time, and decrease the MER trajectory number.
  8,379 293 -
ORIGINAL ARTICLES
Zolpidem increased cancer risk in patients with sleep disorder: A 3-year follow-up study
Sheng-Chiao Lin, Yu-Chieh Su, Yung-Sung Huang, Ching-Chih Lee
March-April 2016, 36(2):68-74
DOI:10.4103/1011-4564.181522  
Background: Zolpidem has been increasingly used in patients with sleep disorder due to its minimal respiratory depressor effects and short half-life. Materials and Methods: Recent case reports indicate that zolpidem usage may be associated with increased cancer mortality. This study aimed to determine the impact of zolpidem usage on the risk of incident cancer events in sleep disorder patients over a 3-year follow-up. Of the 6924 subjects diagnosed with sleep disorder in 2004, 1728 had used zolpidem. A Cox proportional hazard model was performed to estimate 3-year cancer event-free survival rates for patients using zolpidem and those not using it, after adjusting for confounding and risk factors. Results: At the end of follow-up, 56 patients had incident cancers, 26 (1.5%) who used zolpidem, and 30 (0.6%) who did not. After adjustments for gender, age, comorbidities, and other medications, patients using zolpidem had a 1.75 times (95% confidence interval [CI], 1.02–3) greater risk of cancer events than those not using zolpidem during the 3-year follow-up. Greater mean daily dose and longer use were associated with increased risk. Among patients with sleep disorder, mean daily dose >10 mg and length of drug use >2 months was associated with 3.74 times greater risk (95% CI, 1.42–9.83; P = 0.008) of incident cancer events. Conclusions: In this study, zolpidem use increased cancer events risk in sleep disorder patients. Risks and benefits of chronic zolpidem usage should be explained to sleep disorder patients, and long-term use should be monitored.
  7,046 206 -
Depression, anxiety, and heart rate variability: A case-control study in Taiwan
Li-Fen Chen, Chuan-Chia Chang, Nian-Sheng Tzeng, Terry B. J. Kuo, Yu-Chen Kao, San-Yuan Huang, Hsin-An Chang
January-February 2014, 34(1):9-18
DOI:10.4103/1011-4564.129383  
Objective: Decreased heart rate variability (HRV) has been reported in persons with major depressive disorder (MDD), but the results obtained are inconsistent. Little is known about the impact of comorbid anxiety disorders on HRV in MDD patients. Both issues necessitate further investigation. Materials and Methods: Forty-nine unmedicated, physically healthy, MDD patients without comorbidity, 21 MDD patients with comorbid generalized anxiety disorder (GAD), 24 MDD patients with comorbid panic disorder (PD), and 81 matched controls were recruited. The Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale are employed to assess the severity of depression and anxiety, respectively. The cardiac autonomic function was evaluated by measuring the HRV parameters. The frequency-domain indices of HRV were obtained. Results: MDD patients without comorbidity had lower high-frequency (HF)-HRV (which reflected vagal control of HRV) than controls. Any comorbid anxiety disorder (GAD or PD) was associated with significantly faster heart rates, relative to the controls, and caused greater reductions in HF-HRV among MDD patients. MDD participants with comorbid GAD displayed the greatest reductions in HF-HRV, relative to controls. Correlation analyses revealed that the severity of both depression and anxiety were significantly associated with the mean R wave to R wave (R-R) intervals, variance, low-frequency (LF)-HRV, and HF-HRV. Conclusion: The present results show decreased HRV in MDD patients, suggesting that reduction in HRV is a psychophysiological marker of MDD. MDD patients with comorbid GAD had the greatest reductions in HRV. Further investigation of the links between MDD and comorbid GAD, HRV, and cardiovascular disease is warranted.
  5,910 313 2
REVIEW ARTICLE
Oncological emergencies for the internist
Umesh Das, KC Lakshmaiah, TM Suresh, K Govind Babu
January-February 2015, 35(1):1-10
DOI:10.4103/1011-4564.151283  
An oncologic emergency is defined as any acute, potentially life-threatening event, either directly or indirectly related to a patient's cancer (ca) or its treatment. It requires rapid intervention to avoid death or severe permanent damage. Most oncologic emergencies can be classified as metabolic, hematologic, structural, or side effects from chemotherapy agents. Tumor lysis syndrome is a metabolic emergency that presents as severe electrolyte abnormalities. The condition is treated with aggressive hydration, allopurinol or urate oxidase to lower uric acid levels. Hypercalcemia of malignancy is treated with aggressive rehydration, furosemide, and intravenous (IV) bisphosphonates. Syndrome of inappropriate antidiuretic hormone should be suspected if a patient with ca presents with normovolemic hyponatremia. This metabolic condition usually is treated with fluid restriction and furosemide. Febrile neutropenia is a hematologic emergency that usually requires inpatient therapy with broad-spectrum antibiotics, although outpatient therapy may be appropriate for low-risk patients. Hyperviscosity syndrome usually is associated with Waldenstrφm's macroglobulinemia, which is treated with plasmapheresis and chemotherapy. Structural oncologic emergencies are caused by direct compression of surrounding structures or by metastatic disease. Superior vena cava syndrome is the most common structural oncological emergency. Treatment options include chemotherapy, radiation, and IV stenting. Epidural spinal cord compression can be treated with dexamethasone, radiation, or surgery. Malignant pericardial effusion, which often is undiagnosed in ca patients, can be treated with pericardiocentesis or a pericardial window procedure.
  5,764 449 -
ORIGINAL ARTICLES
Ten-year experience of superior gluteal artery perforator flap for reconstruction of sacral defects in Tri-Service General Hospital
Chin-Ta Lin, Nian-Tzyy Dai, Shun-Cheng Chang, Shyi-Gen Chen, Tim-Mo Chen, Hsian-Jenn Wang, Yuan-Sheng Tzeng
March-April 2014, 34(2):66-71
DOI:10.4103/1011-4564.131895  
Background: Despite advances in reconstruction techniques, sacral sores continue to present a challenge to the plastic surgeon. The superior gluteal artery perforator (SGAP) flap is a reliable flap that preserves the entire contralateral side as a future donor site. On the ipsilateral side, the gluteal muscle itself is preserved and all flaps based on the inferior gluteal artery are still possible. However, the dissection of the perforator is tedious and carries a risk of compromising the perforator vessels. Patients and Methods: During the period between April 2003 and March 2013, 30 patients presented to our section with sacral wounds causing by pressure sores or infected pilonidal cysts. Of a total of 30 patients, 13 were female and 17 were male. Their ages ranged from 22 to 92 years old (mean 79.8 years old). Surgical intervention was performed electively with immediate or delayed reconstruction using a SGAP flap. The characteristics of patients' age, and sex, and cause of sacral defect, co-morbidities, wound culture, flap size, perforator number, hospital stay, and outcome were reviewed. Results: For all operations, the length of the pedicle dissection will not exceed 1 cm because of the vascular anatomy of the SGAP, which lies adjacent to the sacral region. Due to short pedicle dissection, all SGAP flap were elevated around an hour. All flaps survived except two, which had partial flap necrosis and were finally treated by contralateral V-Y advancement flaps coverage. The mean follow-up period was 14.8 months (range 3-24). No flap surgery-related mortality was found. Conclusion: Perforator-based flaps have become popular in modern reconstructive surgery because of low donor site morbidity and good preservation of muscle. Our study shows that deep pedicle dissection is unnecessary when the surgery involves an accurate indicating perforator, adequate flap size design, and correct selection of flap utilization between tunnel and rotation. The advantages of this modification include a faster operation, less bleeding, and less trauma of the pedicle, which make the SGAP flaps an alternative choice for sacral sores coverage.
  5,318 418 -
REVIEW ARTICLE
Epidemiology and genetics of osteoarthritis
Donald M Salter, Sui-Lung Su, Herng-Sheng Lee
November-December 2014, 34(6):252-259
DOI:10.4103/1011-4564.147251  
Osteoarthritis (OA) is becoming a significant problem worldwide. Pain and loss of joint function have a major impact on an individual's quality of life and through loss of time at work and increasing health care costs has a significant economic burden on society. OA is a complex disease with a number of known risk factors. There is variable involvement of the synovial joints in populations as a result of both environmental and genetic factors. Recent candidate gene studies and genome-wide association studies are beginning to identify known and previously unsuspected genes to be associated with the development of OA. These studies raise the exciting prospect of future stratification of patients into genetically identified sub-groups that may have specific targetable pathways for disease management.
  5,128 301 2
Overview of clinical trials for dry age-related macular degeneration
Wen-Sheng Cheng, Da-Wen Lu, Chiao-Hsi Chiang, Charn-Jung Chang
July-August 2017, 37(4):121-129
DOI:10.4103/jmedsci.jmedsci_115_16  
The overall goal of treating age-related macular degeneration (AMD) is to target the underlying cause of the disease and prevent, or at least slow down, the loss of vision, which requires the preservation of the choroid, retinal pigment epithelium (RPE), and photoreceptors. At present, there is no proven drug treatment for dry AMD; however, the cessation of smoking and treatments based on the age-related eye diseases study vitamin formula combined with a healthy diet are considered the only options for slowing disease progression. A number of pharmaceutical agents are currently under evaluation for the treatment of dry AMD using strategies such as reduction RPE and photoreceptor loss, neuroprotection, visual cycle modulators, suppression of inflammation, prevention of oxidative damage, and choroidal perfusion enhancers. The hope is that some of these therapies will achieve significant improvement to current management and prevent future loss of vision in this devastating eye condition.
  4,118 709 3
CASE REPORTS
Bipedicled flap reconstruction of soft tissue defect with Achilles tendon exposure
Chin-Ta Lin, Chi-Yu Chen, Shun-Cheng Chang
May-June 2014, 34(3):129-132
DOI:10.4103/1011-4564.134396  
Soft tissue defects exposing the Achilles tendon are common in patients who have undergone trauma or in those with pressure ulcers associated with vascular diseases. Here, we present our recent experience of using a bipedicled fasciocutaneous flap to resurface the complex soft tissue defect and provide a gliding surface for the exposed Achilles tendon. The donor-sites were covered with split-thickness skin grafts and healed well without complications. The bipedicled fasciocutaneous flap survived completely, and the wound healed satisfactorily at 2 months follow-up. The bipedicled fasciocutaneous flap is a reliable flap for coverage of defects overlying the Achilles tendon, especially in patients with vascular problems and/or advanced age. The ease of handling, short operative time, and early recovery of mobilization function are of great benefit to patients. This method can be a valuable alternative for defect reconstructions overlying the Achilles tendon, with satisfactory results both functionally and cosmetically.
  4,528 287 -
ORIGINAL ARTICLES
Care bundle for ventilator-associated pneumonia in a medical intensive care unit in Northern Taiwan
Wen-Ping Zeng, Han Su, Chein-Wen Chen, Shu-Meng Cheng, Li-Fang Chang, Wen-Chii Tzeng, Bing-Hsiean Tzeng
March-April 2015, 35(2):68-73
DOI:10.4103/1011-4564.156013  
Background: Ventilator-associated pneumonia (VAP) occurs in patients requiring mechanical ventilators for more than 48 h. VAP is the most common nosocomial infection and the leading cause of complications and death in intensive care units (ICUs). Materials and Methods: Two historical comparison groups of 375 patients who used mechanical ventilators for more than 48 h in the medical ICU (MICU) from December 1, 2011 to May 31, 2012 and December 1, 2013 to May 31, 2014 were enrolled in this study. There were 194 adult patients in the control group that received traditional care, and there were 181 patients in the experimental VAP care bundle group. Our VAP care bundle entailed several preventive strategies including daily assessments of sedation, daily consideration of weaning and extubation by the doctors and respiratory therapists charged with the care of the patients, maintenance of the intra-cuff pressure values at approximately 20-30 cm H 2 O, hand hygiene, daily oral hygiene, personal protective equipment for suctioning, the placement of patients in semi-recumbent positions with the head of the bed elevated to at least 30°, aspiration of an endotracheal tube and oral cavity prior to position changes, daily cleaning of the ventilator and suction bottle with sterile distilled water, weekly replacement of the ventilator circuit and heater, sterilization of the circuit by pasteurization, and the use of an independent care room. The data were collected by reviewing the patients' medical records and by retrieving information from the Nosocomial Infection Control Unit of one medical center in Northern Taiwan. Results: The incidence of VAP in the VAP care bundle group (0.281 cases per 1000 ventilator days) was significantly lower than that in the control group (0.495 cases per 1000 ventilator days). We estimated that the occurrence of VAP in the MICU increased the medical costs by an average of NT $68317 per patient. Conclusions: VAP care bundle is an effective strategy to reduce the incidence of VAP in the MICU and to reduce healthcare costs.
  4,372 368 1
CASE REPORTS
An isolated chest wall metastasis from cervical squamous cell carcinoma after 19 years of disease-free survival and no local recurrence: A case report and review of literature
Ying-Yi Chen, Chih-Hsin Wang, Wen-Chuan Tsai, Mu-Hsien Yu, Shih-Chun Lee, Hung Chang, Tsai-Wang Huang
November-December 2014, 34(6):272-276
DOI:10.4103/1011-4564.147272  
Chest wall tumors can arise from a wide variety of benign and malignant etiologies, and therefore it can be challenging for clinicians to diagnose and manage them. Isolated metastatic squamous cell carcinoma from cervical cancer is extremely rare. We report a metastatic chest wall tumor from cervical cancer arising after 19 years of disease-free survival. Wide resection of the metastatic chest wall tumor, followed by a polypropylene mesh and free flap reconstruction with adequate coverage was successful. The patient continues to be a disease-free at 2 years.
  4,397 151 -
ORIGINAL ARTICLES
Evaluation of stroke risk associated with the use of typical or atypical antipsychotics among patients with cardiovascular diseases
Meng-Ting Wang, Min-Fang Li, Che-Li Chu, Chin-Bin Yeh, Cheng-Liang Tsai, Jun-Ting Liou
January-February 2015, 35(1):11-18
DOI:10.4103/1011-4564.151284  
Background: Concerns regarding stroke safety associated with the use of atypical antipsychotics among dementia patients have been raised. Although observational studies have found conflicting associations of stroke risk with the use of typical or atypical antipsychotics among the elderly with or without dementia, patients with cardiovascular diseases (CVDs), a high-risk for the stroke population, have not been examined. Little evidence has been provided regarding comparison of the stroke risk between the two antipsychotic classes. This study aimed to evaluate the comparative stroke risk with atypical versus typical antipsychotic use among CVD patients. Materials and Methods: We conducted a population-based nested case-control study analyzing the Taiwan National Health Insurance Research Database from January 1, 1996 to December 31, 2007. A total of 7,460 CVD patients was followed-up, among which 580 hospitalized cases with stroke were identified and matched to 5,398 randomly selected controls. Conditional logistic regressions were employed to quantify the difference in stroke risk associated with atypical versus typical antipsychotics. Results: Any use and current use of atypical antipsychotics were associated with a 1.67-fold (95% confidence interval [CI], 1.21-2.30) and a 2.30-fold (95% CI, 1.56-3.40) increased risk of stroke relative to any typical antipsychotic use, respectively. The stroke risk associated with current use of atypical antipsychotics persisted even compared with current use of typical antipsychotics (adjusted odds ratio, 1.53; 95% CI, 1.02-2.33). Conclusions: Use of atypical antipsychotics is associated with an increased risk of stroke requiring hospitalization compared to typical antipsychotic use among CVD patients. Healthcare professionals should take this risk into account when choosing between typical and atypical antipsychotic treatments among CVD patients.
  4,129 329 1
CASE REPORTS
Fistula in ano presenting as postcoital scrotal discharge
Abhishek Bose, Sandeep Sharma, Jaspal Singh, Harmandeep S Chahal
July-August 2015, 35(4):173-175
DOI:10.4103/1011-4564.163826  
A 32-year-old male presented to us with the history of purulent discharge from scrotum since 5 months ago, with increased amount of discharge during sexual intercourse. Magnetic resonance imaging showed a fistula tract ending at the root of the penis. However, intraoperatively it was found to be communicating with the anal canal. Fistula in ano rarely presents with an external opening in the scrotum. We could not find any published literature in this regard. Complex fistula in ano therefore should be considered in cases of scrotal discharging sinus.
  4,325 120 -
ORIGINAL ARTICLES
Facial biometrics of Yorubas of Nigeria using Akinlolu-Raji image-processing algorithm
Adelaja Abdulazeez Akinlolu
March-April 2016, 36(2):39-45
DOI:10.4103/1011-4564.181520  
Background: Forensic anthropology deals with the establishment of human identity using genetics, biometrics, and face recognition technology. This study aims to compute facial biometrics of Yorubas of Osun State of Nigeria using a novel Akinlolu-Raji image-processing algorithm. Materials and Methods: Three hundred Yorubas of Osun State (150 males and 150 females, aged 15–33 years) were selected as subjects for the study with informed consents and when established as Yorubas by parents and grandparents. Height, body weight, and facial biometrics (evaluated on three-dimensional [3D] facial photographs) were measured on all subjects. The novel Akinlolu-Raji image-processing algorithm for forensic face recognition was developed using the modified row method of computer programming. Facial width, total face height, short forehead height, long forehead height, upper face height, nasal bridge length, nose height, morphological face height, and lower face height computed from readings of the Akinlolu-Raji image-processing algorithm were analyzed using z-test (P ≤ 0.05) of 2010 Microsoft Excel statistical software. Results: Statistical analyzes of facial measurements showed nonsignificant higher mean values (P > 0.05) in Yoruba males compared to females. Yoruba males and females have the leptoprosopic face type based on classifications of face types from facial indices. Conclusions: Akinlolu-Raji image-processing algorithm can be employed for computing anthropometric, forensic, diagnostic, or any other measurements on 2D and 3D images, and data computed from its readings can be converted to actual or life sizes as obtained in 1D measurements. Furthermore, Yoruba males and females have the leptoprosopic face type.
  4,253 171 2
A comparative study evaluating the clinical efficacy of skin tapes versus silicone gel for the treatment of posttrauma scar in the rabbit model
Chih-Chien Wang, Juin-Hong Cherng, Shyi-Gen Chen, Tsai-Wang Huang, Leou-Chyr Lin, Ru-Yu Pan, Yi-Hsin Chan, Chih-Hsin Wang
September-October 2014, 34(5):195-200
DOI:10.4103/1011-4564.143641  
Background: Skin tape and silicone gel are two common over-the-counter preparations used to enhance the cosmesis of keloids and hypertrophic scars of posttrauma wounds. This animal study was performed to determine the clinical efficacy of skin tape versus silicone gel in subjects with scars. Materials and Methods: Three New Zealand rabbits that received total 12 incision wounds which two incision wounds on one ear side and subsequent primary suturing were studied. Stitches were removed after 1 week. Silicone gel was applied right upper side of the rabbit's ear directly on surgical incision wounds, and skin tapes were also applied left upper side of the rabbit's ear directly on another surgical incision wounds after 1 week of surgery. The lower incisions in both ears were covered with sterilized gauze and served as controls. We compared two experimental groups at binaural with using Vancouver Scar Scale, Manchester Scar Scale, and The Stony Brook Scar Evaluation Scale. These are widely used in clinical practice and research to document change in scar appearance. Results: We describe a rabbit model for incisional wounds and scarring outcome measures. The results of scar measuring devices demonstrated that skin tape reduced scar formation as well as silicone gel. Conclusions: The results of cosmetic demonstrated that skin tape reduced scar formation as well as silicone gel. However, the economical and effective materials were the important subject that suffices for clinical requirement. The application of these scar prevention devices to reduce scar formation after surgical incision is worthy of future investigation. Moreover, skin tape may represent a low-cost alternative and low scar formation for closure of surgical incisions.
  4,140 229 -
Caregiver Burden for Patients with Dementia with or Without Hiring Foreign Health Aides: A Cross-Sectional Study in a Northern Taiwan Memory Clinic
Nian-Sheng Tzeng, Chiung-Wen Chang, Ju-Yueh Hsu, Yu-Ching Chou, Hsin-An Chang, Yu-Chen Kao
November-December 2015, 35(6):239-247
DOI:10.4103/1011-4564.172999  
Background: The aim of the present study was to determine the prevalence, profile, and severity of dementia and the relative impact of these factors on caregiver burden in a selected population of persons with dementia and their caregivers. Methods: A convenience sample of 100 outpatients and their family caregivers dyads who presented to a memory clinic in one medical center during one consecutive year were recruited. The diagnosis and severity of dementia were determined according to the Diagnostic and Statistical Manual of Mental Disorders, Version IV, Text Revision. The clinical dementia rating scale, mini-mental status examination, and Clinical Global Impression of severity were also administered. The caregiver strain index was used to assess caregiver burden. Results: Caregiver burden is related to the severity of dementia, impairment of cognitive function, and severity of neuropsychiatric symptoms. The caregivers who were younger, nonspousal family members, had a poor relationship with the dementia patient, and psychosomatic symptoms after caring for the patient, or provided longer hours of care-giving, experienced greater strains. Hiring foreign helpers was not associated with a lower caregiver burden. Conclusions: Greater caregiver burden is associated with several factors related to persons with dementia and their caregivers. A possible over-burden on caregivers should be of concern in Taiwan. Hiring foreign helpers was not associated with a lower caregiver burden.
  4,080 223 10
REVIEW ARTICLE
Age estimation: Current state and research challenges
Abhishek Singh Nayyar, B Anand Babu, B Krishnaveni, M Vaishnavi Devi, HC Gayitri
November-December 2016, 36(6):209-216
DOI:10.4103/1011-4564.196348  
There exist several methods and a fairly substantial literature on the field of age estimation. However, different methods are associated with varying degrees of uncertainty and precision, and this is not always well understood. From a statistical-methodological point of view, there are reasons to believe that a combination of different measurement methods and a more conscious use of the relevant statistical methodology may provide more reliable estimates and better quantification of associated levels of uncertainty. When the uncertainty is known, considering the acceptance level of the error rates, methods are to be found out to rectify it to the maximum possible extent to make it in acceptable limits with maximum validity as there are no methods, by which the age of an individual can be precisely estimated.
  3,805 393 1
CASE REPORTS
Preserve the lower limb in a patient with calcaneal osteomyelitis and severe occlusive peripheral vascular disease by partial calcanectomy
Chin-Ta Lin, Chi-Yu Chen, Shyi-Gen Chen, Tim-Mo Chen, Shun-Cheng Chang
March-April 2015, 35(2):74-78
DOI:10.4103/1011-4564.156016  
Heel ulcers in patients with severe peripheral artery occlusive disease represent a challenge to the treating physician. They become more difficult to treat with underlying medical comorbidities. We report a case of 76-year-old man with hypertension, diabetes mellitus, and end-stage renal disease in uremia status presented to our hospital with a 3-month history of a diabetic foot ulcer on his right heel. He was diagnosed with near total artery occlusion below the knee at the local hospital, and vascular reconstruction failed. After admission, surgical debridement was performed with subsequent partial calcanectomy facilitating wound closure without tension. After surgery, the foot was immobilized with a short-leg splint for 2 weeks. Thereafter, ankle immobilization was accomplished using a thermal protective plastic splint and cast shoes with a posterior window for wound care. The wound healed well with no recurrence during the 12-month follow-up period, and the patient may return to an ambulatory status, including a normal gait pattern. In this case, we demonstrate that the partial calcanectomy is practical for the treatment of plantar heel ulcers in a patient with severe comorbidities. With proper surgical planning and postoperative care, partial calcanectomy is a viable alternative to below-the-knee amputation and may better serve the patient who would otherwise be restricted to a sedentary lifestyle.
  3,724 187 -
ORIGINAL ARTICLES
Antroquinonol, an active pure compound from Antrodia camphorate mycelium, modulates the development of atherosclerosis in a mouse carotid artery ligation model
Tsai-Jung Lin, Yun-Yi Lee, Bieng-Hsian Tzeng, Shih-Ping Yang, Cheng-Wen Ho, Dueng-Yuan Hueng, Jia-Ming Chang, Kun-Lun Huang, Fu-Gong Lin, Ann Chen, Yeukuang Hwu, Shuk-Man Ka
March-April 2014, 34(2):56-61
DOI:10.4103/1011-4564.131888  
Background: Antroquinonol (Antroq) is an active component of Antrodia camphorate. The present study was to validate the preventive effects of Antroq in an atherosclerosis model. Materials and Methods: We examined Antroq inhibitory effect on rat aortic smooth muscle cell proliferation and migration and evaluated its effect on neointima formation and inflammation in mouse carotid artery ligation (CAL). Results: Our data show that Antroq [1] inhibited the proliferation (Antroq [3.0 μg/ml] + PDGF 41.7 ± 7.3%, vehicle + PDGF 134.5 ± 7.3%) (p<0.005) and migration (6h: Antroq [3.0 μg/ml] + PDGF 0.9 ± 0.3%, vehicle + PDGF 25.0 ± 3.4%; 12h: Antroq [3.0 μg/ml] + PDGF 4.0 ± 1.6%, vehicle + PDGF 40.5 ± 2.2%; 24h: Antroq [3.0 μg/ml] + PDGF 14.2 ± 3.0%, vehicle + PDGF 59.8 ± 3.3%) (each, p<0.005) of the cultured smooth muscle cells, [2] prevented neointima formation and reduced N/M ratios in CAL mice (900 μm: Antroq + CAL 0.8 ± 0.3, CAL 3.5 ± 1.1; 800 μm: Antroq + CAL 0.6 ± 0.2, CAL 3.5 ± 0.7; 700 μm: Antroq + CAL 0.7 ± 0.2, CAL 3.8 ± 0.4; 600 μm: Antroq + CAL 0.9 ± 0.2, CAL 3.8 ± 0.9; 500 μm: Antroq + CAL 1.3 ± 0.4, CAL 3.9 ± 0.8; 400 μm: Antroq + CAL 1.5 ± 0.5, CAL 4.0 ± 1.0; 300 μm: Antroq + CAL 1.8 ± 0.6, CAL 3.5 ± 0.6; 200 μm: Antroq + CAL 2.3 ± 0.6, CAL 4.6 ± 1.1) (each, p<0.01), [3] and prevented inflammatory processes and matrix accumulation/fibrosis in the CAL mice. Conclusions: Our data may be useful in developing new and practical strategy for the prevention of atherosclerosis based on the pathogenesis of the disorder.
  3,555 303 -
REVIEW ARTICLE
Diffuse large B-Cell lymphoma-review
Rajeshwar Singh, AP Dubey, Anvesh Rathore, Rajan Kapoor, Durgesh Sharma, Nilabh Kumar Singh, Sachin Maggo
July-August 2018, 38(4):137-143
DOI:10.4103/jmedsci.jmedsci_147_17  
Diffuse large B cell lymphoma (DLBCL) is the most common histologic subtype of non-Hodgkin lymphoma (NHL) accounting for approximately 30 percent of all NHL cases, involving both nodal and extra-nodal sites. Apart from distinct morphological and clinicopathological subtypes, DLBCL can be dived into molecular subtypes, Germimal Centre Subtype (GCB) and Activated B-Cell (ABC) based on gene expression profiling. IPI (International Prognostication Index) and its variants are used to prognosticate the patients. Limited stage DLBCL is primarily treated with combined modality therapy consisting of abbreviated systemic chemotherapy (three cycles), and involved field radiation therapy, whereas advanced stage disease is treated with full course of chemotherapy with recommendation of addition of novel agents ( Bortezomib, Ibrutinib, Lenalidomide) in ABC type DLBCL.
  3,182 610 -
ORIGINAL ARTICLES
In vitro antibacterial and anticancer activity of copper oxide nanostructures in human breast cancer Michigan Cancer Foundation-7 cells
J Emima Jeronsia, DJ Vidhya Raj, L Allwin Joseph, K Rubini, S Jerome Das
July-August 2016, 36(4):145-151
DOI:10.4103/1011-4564.188899  
Objective: The use of nanoparticles (NPs) in cancer diagnosis and treatment is a rapidly developing area of nanotechnology. The main objective of this research work is to synthesize copper oxide (CuO) NPs and to investigate its vitro anticancer and antibacterial property. Methods: The CuO NPs were synthesized via a facile and cost-effective precipitation method using cupric acetate (monohydrate) (CuAc 2 .2H 2 O), sodium hydroxide, and glacial acetic acid. By varying the pH of the precursor solution, the morphology, particle size, and reaction rate of the NPs could be well tailored. The prepared CuO NPs were characterized by X-ray diffraction, ultraviolet-visible spectroscopy, Fourier transform infrared analysis, and scanning electron microscopy. Results: The results revealed a well crystalline structure with leaf-like morphology. By controlling the pH of the solution, particle size and morphology of the NPs are altered. The synthesized CuO NPs have been screened for its antibacterial potency against Gram-positive (Methicillin-resistant Staphylococcus aureus and Bacillus subtilis) and Gram-negative (Salmonella Paratyphi, Klebsiella pneumonia, and Enterobacter aerogenes) bacterial strains. The as-synthesized NPs were found to be remarkable in inhibiting pathogenic bacteria. The anticancer activity reveals the dose-dependent influence of CuO NPs against human breast cancer cell line Michigan Cancer Foundation-7 (MCF-7). Conclusions: The results suggested that CuO NPs have a wide range of antibacterial applications which can be used to control the spread and infection of a variety of bacterial strains. The CuO NPs showed promising anticancer activity against human breast cancer cell line (MCF-7). Overall, CuO NPs are an effective candidate for pharmaceutical, biomedical, and environmental applications.
  3,446 342 9
Prognostic role of lymphovascular invasion and lymph node status among breast cancer subtypes
Guo-Shiou Liao, Huan-Ming Hsu, Chi-Hong Chu, Zhi-Jie Hong, Chun-Yu Fu, Yu-Ching Chou, Mehra Golshan, Ming-Shen Dai, Teng-Wei Chen, Chan De-Chian, Wan-Chen Tsai, Chao-Wen Pan, Kuo-Feng Hsu, En-Nung Kao, Yi-Chih Hsu, Tsun-Hou Chang, Jyh-Cherng Yu
March-April 2018, 38(2):54-61
DOI:10.4103/jmedsci.jmedsci_105_17  
Context: Breast cancer subtype (BCS) and lymphovascular invasion (LVI) have both been independently demonstrated as prognostic factors. Aims: The objective of this investigation was to evaluate the prognostic power of LVI among BCSs. Settings and Design: From an institutional database, 2017 women with a histopathologically confirmed the diagnosis of breast cancer treated between January 2006 and December 2014 were consecutively selected. Subjects and Methods: Information recorded for each patient included age at diagnosis, year of diagnosis, and date of death or last contact. Total incidences of recurrence or death from breast cancer were ascertained from follow-up lasting until 31 June 2013. Institutional review board approval was obtained through our institution's human investigations committee. Statistical Analysis Used: Univariate and multivariate survival analysis were performed using the Kaplan–Meier analysis and Cox proportional hazards model with a stepwise backward elimination to derive a final model of variables with a significant independent relationship with overall survival (OS) and recurrent-free survival (RFS). All statistical analyses were two-sided with significance defined as P < 0.05. Results: For the entire cohort, the median follow-up OS period was 43.2 months. Tumor size, LVI, lymph node status, and treatment factors (operation type, chemotherapy, and hormone therapy) differed among subtypes with respect to OS and RFS. The highest incidence of LVI positivity (26.4% vs. 26.9%, respectively) and lymph node involvement (39.7% vs. 36.4%, respectively) occurred in the luminal B and luminal HER2 subtypes. There were significant differences in the OS and RFS rates according the LVI among the BCS. On multivariate analysis, there were significant differences in OS according to the status of lymph node-negative and LVI-positive in the luminal HER2 subtype, as well as lymph node-positive and LVI-positive in the triple negative (TN) subtype. There were also significant differences in RFS according to the status of lymph node-negative and LVI-positive in the luminal A subgroup. Conclusions: LVI in BCS was an important prognostic factor for OS and RFS. LVI and lymph node status were important prognostic factor for OS and RFS among BCSs. There were significant differences in OS according to the lymph node-negative and LVI-positive in the distribution of luminal HER2, the lymph node-positive, and LVI-positive in the distribution of TN. There were also significant differences in the RFS according to the lymph node-negative and LVI-positive in the luminal A.
  3,445 220 -
The serotonin transporter gene (triallelic 5-HTTLPR polymorphism) may associate with male depression in Han Chinese population
Pei-Shen Ho, Chih-Lun Chen, Chuan-Chia Chang, Hsin-An Chang, Yi-Wei Yeh, Chih-Sung Liang, Che-Hung Yen, Shin-Chang Kuo, Chun-Yen Chen, Chang-Chih Huang, Chun-Long Lin, Ru-Band Lu, Mei-Chen Shih, San-Yuan Huang
March-April 2016, 36(2):59-67
DOI:10.4103/1011-4564.181519  
Background: Pharmacological, neurobehavioral, and therapeutic evidence have implicated serotonin in the pathogenesis of depression. There are conflicting reports on the association of genetic variants of serotonin transporter gene (5-HTTLPR) with major depressive disorder. The 5-HTTLPR is thought to have three primary allelic variants (rs25531): LA, LG, and S. The present study examined whether major depression was associated with tri-allelic 5-HTTLPR polymorphisms in a Han Chinese population. Materials and Methods: Bi-allelic and tri-allelic 5-HTTLPR polymorphisms were assessed in 305 patients with major depressive disorder (MD) and 313 unrelated healthy control subjects. In addition, to reduce clinical heterogeneity, subtype analyses were performed for clinically important variables, including family history of major affective disorder, age at onset, and severity of MD. Results: The bi-allelic 5-HTTLPR polymorphism was not associated with MD and its clinical subgroups. However, the tri-allelic 5-HTTLPR polymorphism was associated with major depression and with specific subgroups. In particular, in male subjects, patients with a low expressing genotype (S'/S') were at higher risk for MD than those with high expressing genotypes (S'/L' and L'/L'). This positive association was only observed in the subgroups of late-onset and moderate severity MD. Conclusions: The present study suggests that the tri-allelic 5-HTTLPR polymorphism might be a risk factor for susceptibility to either MD or its clinical subtypes in the Han Chinese male population but not in the female population. However, these results should be validated in a larger patient population that includes different ethnic samples or subdiagnosis groups.
  3,481 146 1
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