Supraclavicular nerve entrapment syndrome is a rare cause for anterior shoulder girdle pain. This syndrome is usually related to anatomic variants involving the bones, fibrous bands, muscles, and tendons. Here, we report a case of an unusual tendinous insertion of trapezius muscle with the possible entrapment of the supraclavicular nerves. The tendon appeared from the muscle fibers and inserted into the clavicle along the posterior boundary posterior triangle and ran forward above the clavicle and inserted into the clavicle, apart from the insertion of the sternocleidomastoid muscle, along with the few additional slips of the sternocleidomastoid muscle. The supraclavicular nerve coursed downward deep into this variant tendon and its lateral division and then passed through the gap formed between the tendon and the clavicle. In addition to this, the external jugular vein (EJV) passed through the same thin gap. Clinicians should be aware of such rare variations, which might be a possible cause for the supraclavicular nerve entrapment syndrome.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Hypokalemic paralysis in association with febrile thrombocytopenia, especially dengue fever, has been gaining recognition in recent years in India. Till now there have been no reports from western India of this entity. We present here seven cases of hypokalemic paralysis with febrile thrombocytopenia. Two of our cases were dengue-positive. Remarkably, all of our patients were young males 27-40 years of age. All the patients presented with history of fever and quadriparesis, and on investigation had thrombocytopenia with hypokalemia. All the patients responded well to intravenous potassium correction, with complete recovery of motor power. We emphasize that hypokalemic paralysis should be an important consideration in a febrile thrombocytopenic patient presenting with acute quadriparesis.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Retinoblastoma (Rb) is highly a radiosensitive tumor. Radiotherapy has an important role in salvage, consolidative treatment, and that are nonresponding to chemotherapy and other local therapies. A 2-year-old girl known case of Rb, with enucleation of right eye was treated with three-dimensional conformal radiotherapy (3DCRT). Ketamine (1 mg/kg) was used for sedation during radiotherapy. For study purpose, intensity-modulated radiotherapy (IMRT) plan was created and compared with 3DCRT. The 95 and 99% of PTV was covered with 99 and 96% and 97.7 and 92% of the prescribed dose in 3DCRT and IMRT, respectively. Maximum doses to left (Lt) eye was 1.4 and 17.9 Gy, Lt lens was 0.3 and 6.2 Gy, Lt optic nerve was 2.3 and 25.97 Gy, brainstem was 34.99 and 30.08 Gy, optic chiasm was 46.1 and 49.1 Gy, pituitary gland was 45.24 and 46.48 Gy, and the mean doses of brain was 7.24 and 7.02 Gy in 3DCRT and IMRT, respectively. The homogeneity indices were 1.10 and 1.11, conformity indices were 1.54 and 1.40, and total integral dose to brain was 12.6 and 12.9 J in 3DCRT and IMRT, respectively. 3DCRT has decreased dose to OARs as compared to IMRT with better target coverage and also the treatment time in 3DCRT was much less. So 3DCRT in such cases can be considered as a good option, especially when the patient is financially incapable.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Measles still poses a big heath threat in Nigeria. Of concern is the increasing cases of parental/caregiver's refusals of vaccine acceptance which will further worsen efforts to curtail this menace. Measles may cause complication warranting admission. Therefore, this study reviewed common indications for measles admission during the 2013 outbreak. This should serve as a guide on their common presentation and ensure adequate preparation for future outbreaks while efforts are geared toward eradication. Materials and Methods: This research is a retrospective and epidemiological study. Medical records of all cases of measles were reviewed during January-May 2013 and were analyzed, and relevant information were extracted. Results: There were 176 cases of measles; however, 8 files had incomplete data and were excluded from relevant analysis. There were 108 males and 60 females with male-to-female ratio of 1.8:1. Out of all the subjects, 60.7% were not immunized, and only 18.5% had complete immunization. Half of the subjects had bronchopneumonia alone; bronchopneumonia with diarrhea disease was present in 26.2%, while the least recorded case was convulsion with diarrhea disease. Eighty-one percent of the subjects were discharged without complications, only 9 (7.4%) of the 122 well-nourished subjects had complications and 12 (63.4%) subjects with marasmus had most complications and 11 (6.5%) deaths were recorded mostly among the malnourished children. Conclusion: Measles is a health concern in Nigeria; many children are still not vaccinated despite availability of vaccines, and bronchopneumonia and diarrhea diseases are common indications for admission.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Objective: To compare serum procalcitonin (PCT) and endothelin-1 (ET-1) levels in pregnant women with pregnancy-related serious hypertensive disorders (severe preeclampsia and eclampsia) with healthy controls. Materials and Methods: Serum PCT and ET-1 levels were analyzed in 27 cases with severe preeclampsia/eclampsia and 22 healthy controls. Umbilical artery Doppler was performed before the onset of labor. Umbilical artery blood pH and Apgar scores were recorded. The relationship between PCT and fetal well-being was evaluated. Results: The level of PCT was significantly higher in the pregnancy-related severe hypertensive disorders (preeclampsia and eclampsia) than the control group. Apgar scores at minute 1 were lower in the eclampsia group compared to preeclampsia and control group; but, Apgar scores for minute 1 were not correlated with PCT levels (r = 0.2, P = 0.4). There was no significant difference in umbilical artery pulsatility index (PI) values between the groups. There was no significant correlation between umbilical artery PI values and PCT (r = 0.17, P = 0.9). Conclusion: The high levels of PCT confirm that an inflammatory process takes place in the etiopathogenesis of severe preeclampsia and PCT may be used as a marker for severe preeclampsia. A negative fetal outcome has not been associated with high levels of PCT.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Aims and Background: Stem cells derived from Wharton's jelly-derived mesenchymal stem cells (WJMSCs) hold a great therapeutic potential for tissue repair and regeneration and act as a vehicle for gene therapy of multiple human diseases including cancer. The study aims to find the growth of WJMSCs in breast cancer plasma to evaluate their potential in breast cancer therapy. Materials and Methods: WJMSCs at passage 3 were cultured in the plasma isolated from breast cancer patients keeping healthy persons as controls. The effects on cell viability, proliferation, cell death rate, and paracrine factors (VEGF, p53, and p38) were assessed by crystal violet staining, MTT assay, lactate dehydrogenase (LDH) assay, and enzyme-linked immunosorbent assay (ELISA), respectively. Oxidative stress was assessed by the estimation of free radical species malondialdehyde (MDA) and enzymes glutathione (GSH), catalase, and superoxide dismutase (SOD). Results: It was observed that WJMSCs cultured in the plasma of breast cancer patients exhibit decreased viability, slow proliferation, high LDH release, low expression of VEGF while there are high expressions of p38 and p53, and a high oxidative stress. Conclusion: In conclusion, our study demonstrates that a stressed environment of cancer plasma induces injury to the WJMSCs and reduces their viability. The efficacy of these cells for the therapeutics of cancer is reduced in cancer conditions, which necessitates further studies to improve cell survival in cancer conditions.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Recurrent respiratory papillomatosis (RRP) is a benign disease of the upper respiratory tract caused by human papilloma virus (HPV), which can occur at any part of the upper aerodigestive tract. The aim of this study was to determine the prevalence and clinical outcome of RRP in northern Nigeria. Materials and Methods: This study was a retrospective review of patients with the diagnosis of RRP who presented to the National Ear Care Center over a 7-year period (2005-2011). All the case notes of these patients were retrieved, and information gathered from the clinical records were entered into SPSS statistical software and analyzed descriptively. The results were presented in tables and figures. Results: A retrospective review of 24 patients in the age range of 3-51 years with a mean age of 13.4 years was done. There were 14 males and 10 females. The firstborn male children were more affected than the females. The duration of symptoms before presentation varied within the range of 1-276 months, with an average of 48.3 months. Laryngoscopic examination revealed 15 supraglottic, 3 transglottic, and 6 glottic masses. A clinical diagnosis of juvenile-onset recurrent respiratory papillomatosis (JORRP) was made in 20 patients, while adult-onset (AORRP) diagnosis was made in 4 patients. The majority of the patients had direct laryngoscopy and clearance biopsy with tracheostomy (in over 50%). The treatment outcome showed that 18 patients had improved satisfactory postoperative voice, 5 had not improved to their satisfaction, and 1 patient was equivocal. Conclusion: RRP is still a challenge because it has delayed presentation. Juvenile onset is the most commonest. It occurs more among males, first born and treatment still remains DL + biopsy clearance + tracheostomy in our setting.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Rupture of a lumbar artery pseudoaneurysm (LAPA) is a rare cause of significant retroperitoneal hemorrhage. Early diagnosis followed by endovascular transcatheter embolization is a very effective treatment to control bleeding in patients who do not respond to conservative management or where surgery is contraindicated. We report a patient with mycotic pseudoaneurysm of the lumbar artery who was treated successfully with transcatheter arterial embolization. This case highlights that timely intervention can be successful in emergency situations such as active bleeding even if surgery is contraindicated.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]