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  Citation statistics : Table of Contents
   2017| May-June  | Volume 37 | Issue 3  
    Online since June 19, 2017

 
 
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CASE REPORTS
Combination of hypertonic saline and fibrin glue: Another selection to treat chronic enterocutaneous fistula
Po-Chang Hsu, Sheng-Der Hsu
May-June 2017, 37(3):107-109
DOI:10.4103/jmedsci.jmedsci_126_16  
Gastrointestinal tract fistula is a frequent complication of surgery or disease. In general, cases involving failure to manage fistulae after 5–6 weeks of nonoperative treatment possibly require surgery. Here, we report a case involving a chronic enterocutaneous fistula (ECF) for 24 months that was treated using hypertonic saline injection within the duodenal mucosa and use of fibrin glue as an adhesive to ensure rapid closure. This technique is a simple and effective method for treating an ECF. The procedure is easy to perform, carries minimal surgical risk, and features the advantages of reduced hospitalization or home nursing care and expenses compared with traditional therapy.
  - 1,261 110
Cleidocranial dysplasia: A rare case report
Priyanka Minocha, Anita Choudhary, Sadasivan Sitaraman
May-June 2017, 37(3):110-112
DOI:10.4103/1011-4564.208469  
Cleidocranial dysplasia (CCD) is a rare autosomal dominant skeletal disorder, characterized by delayed closure of anterior fontanelle, absent or hypoplastic clavicles, dental problems, and short stature. Usually, the presenting complaints are open anterior fontanelle and dental abnormalities. We hereby present a 5-year-old Indian child who presented to us with the complaints of persistently open anterior fontanelle and short stature. A detailed, thorough examination and high degree of suspicion in a child presenting with persistent open fontanelle has a great importance in the diagnosis of a genetic syndrome like CCD.
  - 1,349 135
A fatal case of drug reaction with eosinophilia and systemic symptom syndrome associated with cytomegalovirus reactivation
Yu-Hsiu Chen, Shun-Neng Hsu, Yu-Lueng Shih, Tsai-Yuan Hsieh
May-June 2017, 37(3):113-116
DOI:10.4103/jmedsci.jmedsci_61_16  
Drug reaction with eosinophilia and systemic symptom (DRESS) syndrome is a severe adverse drug-induced reaction. Diagnosing DRESS syndrome is also challenging due to the diversity of cutaneous eruption and the organs involved. Here, we described an 88-year-old Chinese woman who developed DRESS syndrome under combined therapy of nonsteroidal anti-inflammatory drugs (NSAIDs) and chlormezanone (CM) accompanied with cytomegalovirus reactivation. DRESS syndrome should be highly suspected in patients with symptoms, including skin rash, fever, liver involvement, hypereosinophilia, and lymphadenopathy, especially coexisted with reactivation of the cytomegalovirus. Early withdrawal of the culprit drug is necessary once the diagnosis is established.
  - 1,325 125
Gastrointestinal amyloidosis in a patient with systemic sclerosis
Yu-Hsiang Chiu, Peng-Jen Chen, Yi-Ming Chang, Tsung-Yun Hou
May-June 2017, 37(3):117-119
DOI:10.4103/jmedsci.jmedsci_64_16  
There were more than 90% of systemic sclerosis (SSc) patients developing gastrointestinal tract involvement with affecting esophagus mostly. However, a typical gastrointestinal manifestation may be not the only result of SSc. We described a 70-year-old female with SSc presented poor appetite, intermittent heartburn sensation, nausea, frequent sensation of abdominal fullness, and intermittent dull pain for 2 months. The esophagogastroduodenoscopy showed gastrointestinal as gastroesophageal reflux disease. The biopsy revealed amorphous material deposited in the vascular walls and apple-green birefringence in a polarization examination with Congo red staining which proved amyloidosis. The SSc patient with gastrointestinal involvement suggests to receive esophagogastroduodenoscopy, and a biopsy may be helpful to these patients to examine the possibility of secondary amyloidosis. These patients need more aggressively disease activity control.
  - 1,075 79
ORIGINAL ARTICLES
Application profile of full and abbreviated dossiers for drug master file: An experience of Taiwan
I-Chen Sun
May-June 2017, 37(3):81-85
DOI:10.4103/jmedsci.jmedsci_111_16  
Background: In Taiwan, drug master file (DMF) serves as a useful database regarding the quality of active pharmaceutical ingredients in which both full and abbreviated dossiers can be submitted. Moreover, mandatory substances have been implemented recently, yet the details of the outcome remain unrevealed. Methods: This study aims to compare these two application profiles and their reviewing outcomes. Data were collected from the new submissions of both full and abbreviated dossiers completed between January 1 and December 31 of 2014 by the Center for Drug Evaluation, Taiwan. Results: The top two countries for DMF applications were India and China in both full and abbreviated dossier types. Drugs acting in the alimentary tract and metabolism, cardiovascular system, anti-infectives, and nervous system were the most prevalent. Majority of the abbreviated dossiers provided certification of suitability to the monographs of the European Pharmacopoeia rather than other types of documentation among the eligible documents applying for mandatory applications in which the acceptance rate was higher than that of full dossiers. Conclusions: Our data not only suggests that submission of abbreviated dossier is more effective to receive regulatory approval, but also demonstrates that the policy of health authority is a key in the improvement of reviewing process.
  - 2,164 206
Searching for Suicide Information on Web Search Engines in Chinese
Yen-Feng Lee, Po-Kuan Yeh, Pei-Shen Ho, Dong-Sheng Tzeng
May-June 2017, 37(3):86-90
DOI:10.4103/jmedsci.jmedsci_116_16  
Introduction: Recently, suicide prevention has been an important public health issue. However, with the growing access to information in cyberspace, the harmful information is easily accessible online. To investigate the accessibility of potentially harmful suicide-related information on the internet, we discuss the following issue about searching suicide information on the internet to draw attention to it. Methods: We use five search engines (Google, Yahoo, Bing, Yam, and Sina) and four suicide-related search queries (suicide, how to suicide, suicide methods, and want to die) in traditional Chinese in April 2016. We classified the first thirty linkages of the search results on each search engine by a psychiatric doctor into suicide prevention, pro-suicide, neutral, unrelated to suicide, or error websites. Results: Among the total 352 unique websites generated, the suicide prevention websites were the most frequent among the search results (37.8%), followed by websites unrelated to suicide (25.9%) and neutral websites (23.0%). However, pro-suicide websites were still easily accessible (9.7%). Besides, compared with the USA and China, the search engine originating in Taiwan had the lowest accessibility to pro-suicide information. The results of ANOVA showed a significant difference between the groups, F = 8.772, P < 0.001. Conclusions: This study results suggest a need for further restrictions and regulations of pro-suicide information on the internet. Providing more supportive information online may be an effective plan for suicidal prevention.
  - 1,803 131
Comparative study on the efficacy of tissue autofluorescence (visually enhanced lesion scope) and toluidine blue as a screening method in oral potentially malignant and malignant lesions
Hasan Ali Adil, Monal Yuwanati, Aarti Singh, Suvarna Sawant, Hemant R Umarji
May-June 2017, 37(3):91-96
DOI:10.4103/jmedsci.jmedsci_53_16  
Objective and Study Design: Early identification of high-risk disease could greatly reduce both mortality and morbidity due to oral cancer. Hence, screening of such lesions and their early detection could improve prognosis. Metachromatic dye toluidine blue, which stains nuclear material in dysplastic epithelium, is widely used for screening of potentially malignant lesions. Visually enhanced lesion scope (VELscope) that identifies reduction in tissue fluorescence in dysplasia can also prove to be effective in screening for potentially malignant lesions. Hence, this study was done to compare the reliability of VELscope and toluidine blue as a screening tool in the diagnosis of malignant and potentially malignant lesions as compared to histopathological diagnosis which is gold standard. Materials and Methods: 90 patients with tobacco associated hyperkeratotic red and white lesion, ulcerative lesion, and frank malignancy included in study. Patients were subject to Tissue Autofluorescence (Visually Enhanced Lesion Scope) and Toluidine Blue stain tests. Nature of Autofluorescence and Toluidine Blue staining of tissue was recorded. Based on findings tissue was biopsied and examined under microscope from confirmatory diagnosis. Results: In this study, ninety patients with malignant and potentially malignant lesions were studied, VELscope showed 85.36% sensitivity and 75% specificity as compared to toluidine blue which showed 83.13% sensitivity and 87.5% specificity. The results were statistically significant (P < 0.001) with a mean deviation of ± 3. Conclusion: From the study, we concluded that VELscope was more effective as a screening tool for the detection of oral malignant lesions as compared to toluidine blue.
  - 2,197 234
Outcomes of patients with blunt chest trauma encountered at emergency department and possible risk factors affecting mortality
Yuan-Ming Tsai, Kuan-Hsun Lin, Tsai-Wang Huang, Chun-Ying Chen, Zhi-Jie Hong, Sheng-Der Hsu
May-June 2017, 37(3):97-101
DOI:10.4103/jmedsci.jmedsci_123_16  
Background: Blunt chest trauma is associated with a high risk of mortality. Respiratory complications may necessitate prolonged ventilation and result in death. The present study aimed to investigate possible signs of trauma and the prognosis of trauma patients with thoracic injuries and identify risk factors for mortality. Patients and Methods: A retrospective study was performed to investigate the clinical characteristics and treatment outcomes of trauma patients with blunt chest injuries who underwent thoracic computed tomography on arrival in the emergency department (January 2010–December 2013). Patients with brain injuries were excluded from the study. The prognostic values of age, sex, trauma type, injury severity score, revised trauma score (RTS), ventilator requirement, days in Intensive Care Unit (ICU), associated thoracic injury, and laboratory examinations (including arterial blood gas [ABG]) were evaluated. Results: Fifteen of 30 analyzed patients died during their ICU stays; accordingly, we classified patients as survivors and nonsurvivors. These groups differed significantly regarding the RTS (P = 0.002), mechanical ventilation requirement (P = 0.007), total stay length (P = 0.009), and the presence of hemothorax (P = 0.030). However, no significant differences in the pneumothorax, rib fractures, and blood tests (including ABG analysis) were observed between the groups. Conclusion: Among hospitalized trauma patients with blunt thoracic injuries, RTS, mechanical ventilation requirement, and hemothorax were identified as risk factors for mortality. Patients with hemothorax should receive multidisciplinary care and be monitored closely to improve survival.
  - 3,333 373
The accuracy and interobserver reliability of identification of interalveolar foramina in the mandible using dental radiography
Chang-Kai Chen, Hsiao-Pei Tu, Da-Yo Yuh, Gou-Liang Cheng, Earl Fu
May-June 2017, 37(3):102-106
DOI:10.4103/jmedsci.jmedsci_38_16  
Background: The evaluation of periapical radiographic evidence of these foramina might be helpful to avoid hemorrhaging of the highly vascularized regions of the floor of the mouth. Accuracy and reliability of the dental radiography in depicting the interalveolar medial foramina on 28 dry mandibles was tested in this study. Materials and Methods: The 28 mandibles were radiographically examined for the presence of median and lateral foramina that were interalveolar. The foramina diameters and the distance of the foramen to the cementoenamel junction, and to the alveolar bone crest, were measured. Two radiographic images of the symphysis areas were obtained, with and without the insertion of metal wires into the foramina. On the radiographic films, the presence of the foramina was identified and marked by two periodontists. The accuracy, sensitivity, specificity, interobserver reliability and the agreement of the readings between the diagnostic films and the films with wire insertions were analyzed. Results: Two to four foramina were observed on the lingual surfaces in the symphysis areas in 27 dry skulls. Among the 52 median foramina, 22 and 21 foramina were identified by observers 1 and 2, respectively. The accuracy, sensitivity, and specificity for the identification of the foramina were 41.1%, 42.3%, and 25.0%, respectively, for observer 1, and 37.5%, 40.4%, and 0.0%, respectively, for observer 2. The interobserver reliability was 0.57 (Kappa value). The readings for the diagnostic films and those for the films with wire insertions showed no agreement, regardless of the observer. Conclusions: Dental radiography revealed the presence of interalveolar foramina in 28 skulls; nonetheless, this result should be interpreted cautiously, as the accuracy was <50%.
  - 1,172 113
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