Volume 02 Issue 10 October 2014

Citation

Title: Influence of Immediate and Long Term Effects of Repetitive Transcranial Magnetic Stimulation Combined with Speech Therapy on Post Stroke Non-fluent

Authors: Moshera H. Darwish, Aphasia Mohamed S. El-Tamawy, Hala R. El-Habashy, Sheen I.

Paper Index: 10.2014-82225847

Abstract

Background: A high proportion of patients who have suffered a stroke also suffer from aphasia.

The aim of this work was to determine and investigate immediate and long term effects of repetitive transcranial magnetic stimulation combined with speech and language exercise therapy on non fluent motor aphasia (Broca's aphasia) in chronic cerebrovascular stroke.

Methods: Forty chronic cerebrovascular stroke patients represented the sample of the study. Their age ranged from 45 to 60 years. The patients were assigned randomly into two equal groups; study group (G1) and control group (G2). The patients in both groups received the same medical and physical care during treatment period to avoid any complications. The study group treated by selected speech exercises combined with rTMS. Different domains of speech function (repetition, reading, naming, writing, comprehension and spontaneous speech) were assessed by the Arabic translated form of the modified Chesher test and Token test of Aachen aphasia test (AAT). Power of stimulation intensity of rTMS (represents 90% of the resting motor threshold that recorded from contraction of the first dorsal interosseus of the unaffected hand) were measured pre, post and after three months of the end of the treatment to determine level of brain excitability.

The Results: At the end of the treatment there was a significant improvement in all domains in (G1) of the Arabic translated form of the modified Chesher test. In the control group (G2) there was a change in total score of the Arabic translated form of the modified Chesher test in approximately all domains but not reach to significance level (P<0.05) except auditory comprehension and pantomime there was a significant increase (P>5). Comparison of mean values of all domains of (G1) and (G2) post treatment indicate significance improvement of all different domains measured by clinical tests or rTMS in (G1). A significant decrease in the mean value of power intensity of rTMS post treatment in (G1) was observed (P<0.05). There was a Strong negative correlation between improvements in total score of the Arabic translated form of the modified Chesher test and the decrease of the mean values of power intensity of rTMS in (G1).

Conclusion:Speech exercises combined with rTMS permit the mechanisms of transcortical disinhibition to enhance language function in chronic non- fluent aphasia post stroke patients. Low frequency rTMS delivered over Broca's area could improve language by enhancing long-term potentiation and synaptic plasticity within the stimulated areas involved in language network.

Keywords: Non-fluent motor aphasia modified Chesher test, rTMS, rehabilitation, stroke, language.

Citation

Title: Masking the Drawbacks of Surgical Closure of Failed Oroantral Fistula Correction with a Partial Denture Prosthesis

Authors: Nishant Gaba, Khurshid A. Mattoo, Amit Sivach

Paper Index: 10.2014-96837264

Abstract

Proximity of maxillary sinus with the maxillary posterior teeth makes it vulnerable to be exposed during difficult extractions. When the sinus is exposed during extraction it is usually closed by surgery. Many times these closures are not either complete or fail to close because of patient related factors. Therefore it becomes significant for surgeon to follow strict protocol of following up such patients. This article describes a case where the same was not done properly and has forensic applications. The fistula present in this case is small which was not observed by examiners at three different levels before being finally diagnosed. The article also reiterates the significance of doing complete examination in such cases. The patient was successfully rehabilitated using a modified partial denture.

Keywords- maxillary antrum, maxillary molar, obturator, surgical extraction

Citation

Title: Comparing the Effect of Two Different Dual Task Training Conditions on Balance and Gait in Elderly

Authors: Money Rajput, Sunil Bhatt

Paper Index: 10.2014-94185685

Abstract

AIM: Aim of this study is to assess the appropriate strategy between (two) different dual task (cognitive-motor and motor-motor) for improving balance and gait in elderly people.

Methodology: 60 Subjects were randomly selected from the community who volunteered to participate in the study. Subjects were randomly assigned in to three interventions: cognitive-motor dual task training, motor-motor dual task training and single balance training. Subjects were received 45 minute individualized training sessions 3 times a weeks. Outcome measure; BBS, POMA, OPQOL were collected at before and after intervention.

Results: Subjects in all groups improved on the BBS, POMA and OPQOL. When we compared the three groups, we found that cognitive-motor dual task training was far superior than either motor- motor dual task training and balance training. Significant improvement in balance , gait and quality of life (p<0.05) Also out of motor-motor dual task training and balance training, balance training group showed better improvements.

Conclusion: It can be concluded from our study that the cognitive –motor dual task training is better than motor-motor dual task training and balance training over the balance, gait and quality of life in elderly.

Keywords: Berg Balance Scale (BBS), Performance Oriented Assessment Scale (POMA), Older People Quality Of Life (OPQOL) and Aging.

Citation

Title: Effect of Functional Electrical Stimulation on Foot Drop for Patients with Cerebro Vascular Accident

Authors: Saha Sangeeta, Chauhan Vivek, Ingole Gaurav

Paper Index: 10.2014-76553113

Abstract

Need of Study-This study is to determine whether Therapeutic exercise and Functional Electrical Stimulation application on Dorsiflexors for a foot drop post stroke (cerebrovascular accident) subject could improve their functional ability and prevent foot drop,

Sample size 30 all the subjects were taken from TRA General, Hospital,Kolkata

Study Design – Random Sampling, This study includes 30 numbers of subjects in two Groups ,Group A 15 subject and Group B 15 subject in both genders in randomly selected Age – 40-60yrs. Subject were taken after Six month post stroke without tendoachilis contracture.

Outcome Measures – POMA, ROM.

Results- shows that significant positive value in group A & B both depict that effect of treatment is significant. In group A, p value is (.000) and t value (-8.103), so it is statistically significant. In group B, p value is (.000) and t value is (-7.519) that mean it is also statistically significant. So, both the effect therapeutic exercise experimented on group A and the effect of Functional Electrical stimulation experimented on group B to increase dorsiflexion and also planter flexion for post stroke subjects is found significant.

Conclusion: The present study found significant positive effect in case of good life and Walking Patterns by (POMA & ROM) by using Functional Electrical Stimulation (FES). There is positive result in case of Therapeutic Electrical Stimulation (Faradic Stimulation).

Key Words- Foot Drop, Six Month Post Stroke Subject, FES, NMES and Therapeutic Exercise For Foot Drop

Citation

Title: To Determine the Efficacy of Neural Mobilization in Reducing Pain and Increasing Functional Ability in Patients with Cervical Radiculopathy

Authors: Bag Soumen, Chauhan Vivek , Ingole Gaurav

Paper Index: 10.2014-73347681

Abstract

Need and Purpose- To find out the efficacy of neural mobilization in reducing pain and increasing functional ability in patients with cervical radiculopathy .

Study Design- random sampling

Participant’s 30 subjects recruited from different health centres and hospitals of West Bengal.

Outcome Measures: NPRS, PSFS (patient specific functional scale)

Result: the effect of treatment is significant for both group A and group B by application of Pre and Post PSFS. Here t value is statistically significant with p value (.000) in group A and p value (.000) in group B. So for both the group the effects of the treatment are statistically significant .

Conclusion:On comparison of correlations we found that Neural Mobilization along with Neck exercise is more effective than only neck exercise assessed by using PSFS & NPRS.

Key Words: cervical radiculopathy,NPRS ,neural mobilization ,PSFS.

Citation

Title: Prosthetic Protection of a Healing Bone Defect Caused as a Result of Chronic Suppurative Osteomyelitis of The Mandible

Authors: Khurshid A Mattoo, Surendra P Singh, Krati Mishra

Paper Index: 10.2014-85832186

Abstract

Osteomyelitis of the jaws in any of its forms is rarely encountered by a prosthodontist for rehabilitation. Though acute forms of osteomyelitis are considered as dental emergency, its chronic forms are usually associated with the destruction of the jawbone in either maxilla or the mandible. Prosthetic protection is required temporarily till the lesion heals, but dental rehabilitation is required due to tooth loss. This article is a case report of a patient who had undergone surgery and required a device to protect the area. The design of such a device is also discussed along with the anatomy of the defect.

Keywords-trabeculae, medically compromised, suppuration, antibiotics

Citation

Title: Self-Neglect Associated With a Patient Having Oral Cancer

Authors: K Nagaraj, Khurshid A. Mattoo, Anchal Brar

Paper Index: 10.2014-86343786

Abstract

The prevalence of oral cancer has increased in the last few decades with the advent of increased availability of tobacco and related products. This in turn has also given rise to the problems associated with it. One significant problem that needs to be understood scientifically is psychosocial effects of oral cancer. Though uncommon, self-neglect is an area which has not been investigated in patients with oral cancer. This article as a clinical case report describes a patient who was diagnosed with oral cancer, which in turn had psychological impact on him in the form of self-neglect. Various scientific factors have also been discussed.

Keywords-tongue, carcinoma, ulcer, radiation, chemotherapy

Citation

Title: Clinico-Heamatological Study of Dengue in Adults and the Significance of Total Leukocyte Count in Management of Dengue

Authors: Neelakandan Ramya , Sethu Prabhu Shankar

Paper Index: 10.2014-81389418

Abstract

Background: Dengue is the most rapidly spreading mosquito borne viral disease in the world. There is an increase in incidence of dengue in adult population in South Asian countries in recent years.

Objective: To study the pattern of dengue in adults and the significance of total leukocyte count in assessing the clinical course of dengue.

Materials & Methods: All adult patients admitted with fever and features suggestive of dengue infection were included in the study. Serological testing for dengue virus specific antigen and antibody was done for the diagnosis of dengue fever. The demographic data, clinical features, hematological and biochemical parameters were collected. The World Health Organization classification and case definitions 2009 was used to categorize the dengue patients. The variable pattern of the disease and the importance of total leukocyte count in the monitoring of the natural course of the illness were studied.

Results: Of the total 169 patients admitted with suspected dengue infection, 74 were diagnosed with dengue serologically. Of these 74 patients, 31(41.9%) had primary dengue infection and 43 (58.1%) had secondary dengue infection. Number of patients who had probable dengue, dengue +warning signs and severe dengue were 39 (52.7%), 24 (32.4%) and 11 (14.9%) respectively. Petechiae was seen in 22 (29.7%) patients, tender hepatomegaly in 18 (24.3%). A very low total leukocyte count and a very low platelet count along with a drop in haematocrit was seen in 11 (14.9%) patients. The leukopenia preceded the fall in platelet count by 24 ± 12 hours and the recovery of platelet count was also preceded by the recovery of total leukocyte count by 24 ± 12 hours.

Conclusion: This study highlights the pattern and the natural course of dengue in South India. It is evident that the total leukocyte count plays a significant role in predicting the natural course of the dengue in both critical as well as the recovery phase of the illness. There is increased association of severe leukopenia with severe thrombocytopenia and severe dengue.

Keywords: Dengue, leukocyte count, platelet count, haematocrit.

Citation

Title: Anomalous Cerebral Vasculature and Bilateral Anterior Circulation Stroke: A Case Report

Author: Dr.Srikanth Ramadhenu, Dr.Ravikanth Ramadhenu, Dr.Rajendra Prasad, Dr.S.Balasubramaniyan

Paper Index: 10.2014-39974296

Abstract

Introduction: Simultaneous bilateral cerebrovascular infarction is relatively rare and its initial presentation as a space-occupying lesion is extremely uncommon. However, bilateral infarction can result from unilateral occlusion of anomalous cerebral vasculature.

Case Presentation: We report the case of a man presenting with lower limb weakness and aphasia of acute onset with initial computerised tomography suggesting bifrontal neoplasm. However, further investigation confirmed bilateral anterior cerebral artery territory infarction with a hypoplastic left anterior cerebral artery with the right anterior cerebral artery supplying both frontal lobes (an anatomical variant). We present the clinical and diagnostic features of this presentation and attempt to ascertain, by reviewing existent medical literature, the frequency and patterns of structural variations in cerebral vasculature.

Conclusion: Simultaneous bilateral cerebral infarction can be the result of a unilateral cerebral artery occlusion and this can potentially mimic a space-occupying lesion. Anomalies of cerebral vasculature are not as rare as is usually believed and this should be borne in mind when investigating unusual presentations of cerebrovascular infarction.

Citation

Title: Effect of Coagulation Profile in Third Trimester of Pregnancy

Author: Dr Tazkira Begum, Dr Wasima Jahan, Dr Rwitusmita Bharali, Dr Syed Md Ibrahim Kabir

Paper Index: 10.2014-41592833

Abstract

Normal pregnancy associated with many changes in coagulation profile. These changes are important for intrapartum blood loss and also for thromboembolism during pregnancy and labour. The present study aimed at to find out the quantitative change in coagulation profile in early and later part of third trimester. This study was carried out in the Department of physiology, AMC, Dibrugarh, Assam. 50 cases of pregnant women in third trimester are enrolled for the study. Among which 29 cases are in 29th to 34th wks and 21 cases are within 35th to 39th wks of gestation. For control 50 age matched healthy female of child bearing age group are taken. Platelet count, Bleeding time and coagulation time were done in each control and cases. The mean platelet count in pregnancy at 29th to 34th wks was more than that of non pregnant but the value was less in pregnancy at 35th to 39th wks. Similarly mean bleeding time and coagulation time was also increases in third trimester than the non pregnant. But both the values are decreases in 35th to 39th wks than the 29th to 34th wks. Platelet count was progressively decreased in later part of pregnancy women compared to nonpregnant women. It is partly due to hemodilution and partly due to increased platelet activation and accelerated clearance (Shehlata et al., 1999 and McCrae, 2010).To conclude thromboembolism and bleeding disorder are two major complications of pregnancy. So to prevent the complication proper study of coagulation profile is necessary.

Key words: Platelet count, bleeding time, coagulation time, third trimester, thromboembolism.

Citation

Title: Homicidal Strangulation When Victim Was Under Alcohol Influence – A Case Report

Authors: Rajesh SangramUdgire, Chandrashekar J

Paper Index: 10.2014-41137249

Abstract

Strangulationof the person under the influence of alcohol is one of the commonest method of Homicide may be because the person under the influence of alcohol shows minimum resistance for the act. We present one such case where the deceased was strangulated to death who was under the influence of alcohol. Even the Investigating officer had no idea about ligature strangulation. They gave history of heavy alcohol consumption and fall. But on keen post-mortem examination it was concluded that death is due to homicidal strangulation. Hence the role of forensic expert is of paramount importance to bring culprits to justice.

Keywords: Strangulation, Under the Influence, Homicide

Citation

Title: Giant Mesenteric Cyst, Presentation as Acute Appendicitis in Adult: A Rare Case Report

Authors: Dhukiya Ramniwas, Kajla Ramakishna, Dhukiya Saroj, Sinwar Prabhu Daya, Chouhan S.P

Paper Index: 10.2014-65294537

Abstract

Introduction - Mesenteric cysts are uncommon benign abdominal lesions with no classical clinical features. The preoperative diagnosis requires the common imaging modalities but the final diagnosis established only during surgery or histological analysis. The treatment of choice is complete surgical excision. Case report- We report a 25-year-old male with a non-specific abdominal pain and discomfort since 15 days. USG finding suggestive of large collection in right ileac fossae and pelvis. Expletory laperotomy was done and during intraoperative a large mesenteric cyst was found. The cyst was completely removed and histology report confirmed mesenteric cyst without evidence of malignancy. Conclusion- Mesenteric cyst is rare tumor that more common in children. They may be presented various clinical symptom. Mesenteric cyst best treated as resection anastomosis

Keyword: Mesenteric cyst, Large collection, Malignancy, laparotomy, Resection anastomosis

Citation

Title: Antibiotic Susceptibility Pattern of Bacterial Isolates in Neonates at a Children Hospital, Nigeria

Authors: Shittu Mujeeb O, Orisadare Olayiwola P, Jikeme Osemeke E, Shittu Bashirat T, Bello Lateef A, Oluremi Adeolu S

Paper Index: 10.2014-11159795

Abstract

Blood-stream infection is one of the leading causes of neonatal mortality. Neonatal septicemia is a common complication for neonates in neonatal intensive care unit around the world. The aim of this study was to isolate and identify the bacteria responsible for neonatal septicemia and to determine the susceptibility pattern of isolates in Outreach Children’s hospital in Festac town, south-western Nigeria. 432 blood samples were collected for this study. The samples were processed in accordance with standard protocols. Antibiotic susceptibility of isolates was done by disc diffusion technique according to British Society for Antimicrobial Chemotherapy. Blood culture reports were positive in 22.2% cases. Early-onset sepsis was present in 65.6% and late-onset sepsis was observed in 34.4% of the cases. The most common isolates were Klebsiella spp 34.3% and S.aureus 28.1%. Gram-negative isolates were mostly susceptible to ofloxacin 90%, followed by ciprofloxacin 65%. Best overall susceptible antibiotics among Gram-positive isolates were ciprofloxacin 83.3% and ceftazidine 83.3%. In conclusion, this present study showed that both Gram-negative and Gram-positive bacteria were responsible for neonatal septicaemia and the majority of the isolates were multidrug resistant. This urges us to take infection prevention measures and to conduct other large studies for appropriate empiric antibiotic choice.

Keywords: Antibiotic susceptibility, bacterial isolates, neonates, Nigeria

Citation

Title: Study of Blood Pressure Changes with Altitude at Shimla

Authors: Dr. Meenu Agarwal, Dr. Narinder Mahajan

Paper Index: 10.2014-63156153

Abstract

Objective: Residence at high altitude has been associated with elevation in systemic blood pressure. This study was designed to determine the effects of median altitude on blood pressure.

Methods: 100 subjects were interviewed and their blood pressures were measured at Shimla (India) located at a height of 2,205 meters. Their previous blood pressures at lower altitudes of approximately 271 meters were noted from their previous records as well as from their statements.

Results: Mean Arterial Pressure was found to be increased in 82 subjects.

Interpretation: Our findings imply that moderate altitude living results in significantly greater blood pressure

Key words: altitude, blood pressure

Citation

Title: Oral Hygiene Status and Gingivitis Among Undergraduate Dental Students- A Descriptive Survey

Authors: Dr Mranali K Shetty, Dr Karthik Shetty, Dr Bijju Thomas, Dr Ramya Shenoy, Dr Shilpa Shetty

Paper Index: 10.2014-73432776

Abstract

The importance of personal hygiene is a very variable concept for every individual and the routines for its maintenance frequently differ from person to person. Dentist’s attitudes toward their oral health have been found to affect the quality of care delivered to their patients. Incorporating good oral hygiene attitudes into dental students early during their under graduate years will help ensure that they inculcate these into their everyday routines throughout their lives. Researchers have found oral health attitudes and behaviors among dental students to be different in their pre-clinical and clinical years.

Gingivitis has been seen to be one of the most predominant dental maladies affecting the general population. The aim of this study was to assess the prevalence of Gingivitis among dental students. In the current study, Oral Hygiene Index Simplified, and Gingival Index were used to assess the oral hygiene status of 500 dental students. Results showed 87.8 % (439) had good oral hygiene , 9 %(45) had fair oral hygiene and 3.2 %(16) had poor oral hygiene. About 85% (425) of the participants reported mild gingivitis, 10% (50) of the participants had moderate gingivitis and 5% (25) of the study subjects suffered from severe gingivitis. It was also found male dental students had higher bleeding and worse hygiene as compared to the female dental students.

Keywords- Oral hygiene, Gingivitis, Dental students

Citation

Title: Impact of Marital Status on Mental Health of Working Women

Authors: Mishra Garima, Dr. Kiran U. V.

Paper Index: 10.2014-99174691

Abstract

Mental health can be defined as the ability to make adequate social and emotional adjustments to the environment, on the plane of reality. Mental health of working women was assessed in the present study. Marital status of women strongly impacts the mental health and their performance at job. Hence the present study focuses on Impact of marital status on mental health of working women. The study was carried out in Lucknow on the women working in various institutions using stratified random sampling technique. A total of 90 working women were selected from various sectors. Self made questionnaire for the assessment of mental health was used in the present research. Research revealed that marital status has significant impact on the mental health of working women. The multifaceted stress of married working women with responsibilities at various arenas may be the reason for their weaker mental health. Proper counseling time appropriation and meditation may be the best remedies for the improvement in their mental health.

Keyword: mental health, marital status, marital adjustment, working women.

Citation

Title: A Rare Case of Optic Nerve Schwannoma in Neurofibromatosis

Authors: Dr.P. Rawat, Dr.U.Srivastava, Dr. Sachin Tammannavar, Dr.Narmada Prasad Tiwari, Dr.Neetu Kori

Paper Index: 10.2014-65211345

Abstract

A highly unusual patient of neurofibromatosis with optic nerve schwannoma is reported. Orbital mass with visual loss were presenting features. Complete excision of mass with debulking was done. Diagnosis of optic nerve schwannoma was confirmed by histopathological examination. Optic nerve glioma and meningioma are common in neurofibromatosis while optic nerve schwannoma rarely occurs in this disease. This patient enlarges the spectrum of clinical presentations that can be encountered at young age in patients with neurofibromatosis.

Key words: neurofibromatosis, schwannoma, optic nerve, histopathology

Citation

Title: Encephalotrigeminal Hemangiomatosis: Two Case Report

Authors: Dr. Muthu Kumar.S, Dr. Mohsin Khan, Dr. Mubeen, Dr. Vijayalakshmi. K.R

Paper Index: 10.2014-86484633

Abstract

Encephalotrigeminal Hemangiomatosis also known as sturge- Weber syndrome, is specifically congenital, non-hereditary, rare condition occurring with a frequency of 1:50,000 live births, with equal predilection for either sex . This syndrome consists of a constellation of clinical features like cutaneous angiomatosis (Port-wine stain), glaucoma and variable neurological manifestation including seizures with or without mental retardation.

Two male patients aged 17 and 29 year old reported to our department at different time interval with a complaint of swelling in the upper lip since 4 and 2 years respectively. Similar features of reddish discoloration noted in right side of face since childhood was reported by both the patients, there was no history of trauma or pain. However there was positive history of seizure in one of the patient. This paper reports two cases of this syndrome in detail with classic oral manifestations, radiological features and management.

Conclusion:- Dentists play key role in identifying oral manifestations and aid in early recognition of this syndrome and prevent cranial complications thereby improving the prognosis.

Key words:- Encephalotrigeminal Hemangiomatosis , Sturge- Weber syndrome (SWS), Port wine stains, angioma.

Citation

Title: Study of Peptic Ulcer Perforation in 80 Cases

Authors:Dr.Jitendra.T.Sankpal,Dr.Vivek.P.Tilwani,Dr.Tushar Walvi, Dr.Vijay Nikale, Dr.Aashish Hatkar

Paper Index: 10.2014-54342232

Abstract

Peritonitis following perforation of digestive tract remains an important problem in the field of surgery. In this study of 80 cases, males were(86.25%)and females were (13.75%).Common age of peptic ulcer perforation being less than 40 years, pain is most common presentation, guarding and rigidity common signs. Mortality and morbidity increases with increase in duration of presentation. Ant. duodenal wall is most common site, E.Coli being common organism in peritoneal fluid, common proccedure done was primary closure and omental patch done in 96%cases, with 90% cases completely recovered.

Citation

Title: Right Subcostal Incisional Hernia: A Surgical Challenge

Authors: Dr.Ketan Vagholkar, Dr.Abhijit Budhkar, Dr.Jagruti Gulati

Paper Index: 0.2014-82354194

Abstract

Subcostal incisional hernia invariably poses a surgical challenge due to the variability in its anatomical contents. Preoperative contrast enhanced CT scan of the abdomen provides an excellent road map for ascertaining the contents and planning a safe repair. Open mesh repair is the safest option for subcostal incisional hernias with multiple adherent contents

Keywords: subcostal, incisional, hernia, mesh, open, laparoscopic repair

Citation

Title: Study of Blunt Abdominal Trauma-200 Cases

Authors: Dr.Jitendra.T.Sankpal, Dr.Vivek.P.Tilwani, Dr.Manjiri Sankpal, Dr.Tushar Walvi, Dr.Vijay Nikale

Paper Index: 10.2014-16685978

Abstract

Clinical presentation & management was evaluated in prospective randomized trial in 200 cases. Males were (84% ) and females were (16%), among study group, age group (21-40) years, were commonly involved, the( 88%) patients presented with abdominal pain and (72% )presented with rigidity. X ray chest and abdomen and sonography forms important initial investigations Most common injured organ were Spleen (38%), liver (30%), bowel (18%), kidney (6%), mesentry (4%) gall bladder (2%).In this study clinical presentation and its conservative versus operative management was also studied.

Citation

Title: A Randomized Control Study to Find the Efficacy of Pursed Lip Breathing in Lung Volumes and Capacities of Patients with Chronic Obstructive Pulmonary Disease (COPD)

Authors: Dr. Heera Vijayakumar, Dr. P. Vijayakumar

Paper Index: 10.2014-54994426

Abstract

Objective- Efficacy of pursed lip breathing with medical management compared to only pursed lip breathing in lung volumes and capacities of patients with COPD.

Study Design- Pre and post experimental study design

Setting- The study was conducted in Pulmonary Rehabilitation unit of Navodaya Medical College Hospital and Research Center, Raichur.

Participants- 30 patients who were suffering from mild to moderate symptoms of COPD were randomized into two groups by using simple random technique. They were experimental and control groups respectively.

Interventions-30 subjects who were diagnosed with stable COPD were randomly allocated into experimental and control groups. Both the groups received medication of oral Theophylline + MID of Salbutamol and Ipratropium Bromide. However, experimental group received an additional intervention of pursed lip breathing.

Outcome Measures-Spirowin Computerised Spirometry

Results-There was a statistically significant improvement within the group for both the groups in all the parameters of lung volumes and capacities when compared pre and post test values. Whereas, there was highly significant post test difference in Tidal volume(P<0.02) and Maximum Voluntary Ventilation(P<0.001) in the experimental group when compared with the post test values of control group suggestive of the effect in the parameters of TV and MVV, which are an integral part of improvement of patients symptoms in COPD. But there was no significant difference in FEV1, FVC, FEV1/FVC ratio between the experimental and control groups after the treatment(P>0.05).

Conclusion: Present study concludes that there was no significant difference in pre test of treatment in both experimental and control groups. Significant improvement in TV and MVV in the experimental group and no significance difference was found in FEV1, FVC and FEV1/FVC ratio in control group in post test of treatment.

Keywords :MVV- Maximum Voluntary Ventilation, TV- Tidal Volume,FEV1- Forced expiratory volume within 1 second, FVC- Forced vital capacity, PLB- Pursed Lip Breathing

Citation

Title: A Study of Cytological Evaluation of Cervical Lymphadenopathy in Konaseema Region

Authors: Dr Vinay Kumar R, Dr B Rammohan Rao, Dr Epari Sanjeeva Rao

Paper Index: 10.2014-18526127

Abstract

Background: Cervical lymphadenopathy is a common clinical problem that presents to us in day today clinical practice. The causes vary from simple treatable infections to malignancies which needs to be investigated. Fine needle aspiration cytology (FNAC) is simple, quick, inexpensive and minimally invasive technique that can be used as an outpatient procedure to diagnose them.

Aims and objectives: 1) To know the overall prevalence of various causes responsible for cervical lymphadenopathy.

2) To know the distribution of various lesions among the age & sex groups.

3) To emphasize the role of fine needle aspiration cytology (FNAC) in etiologic workup in significant cervical lymphadenopathy.

Material and Methods: FNAC was performed on 90 patients who presented with cervical lymphadenopathy to department of Pathology over a period of 6 months

Results: The maximum numbers of patients (42.22%) were diagnosed as Tuberculous lymphadenitis, followed by Reactive lymphadenitis (30%), Acute suppurative lymphadenitis (15.5%) and Malignant metastatic deposits (12.22%). Reactive lymphadenitis is the commonest cause of cervical lymphadenopathy in pediatric age group, Infective in 11-40 yrs age group including Tuberculous and Suppurative lymphadenitis, Malignant metastatic disease in more than 40yrs age group.

Conclusion: FNAC is simple, quick, minimally invasive, and inexpensive diagnostic modality for the etiologic workup of cervical lymphadenopathy and is almost as sensitive and specific as excision lymph node biopsy when an adequate aspirate is examined by expert eyes.

Key Words: Cervical lymphadenopathy, FNAC, Tuberculous lymphadenitis, Reactive lymphadenitis

Citation

Title: Evaluation of Culture Methods for Identification of Dermatophytes

Authors: Dr.Rajeshwari K. Gangulappa, Dr.Morubagal Raghavendra Rao, Dr.Tejashree A, Dr.Madhuri Kulkarni, Dr.Ranjitha Shankare Gowda

Paper Index: 0.2014-28979967

Abstract

Dermatophytosisare of worldwide distribution, Epidemiological studies concerning dermatophytes infection have been performed and the differences in the etiological agents have been noted. The present study was undertaken to isolate & detect the etiological agents of dermatophytosis up to species level by microscopy & culture, & to evaluate the culture methods. A total of 72 clinically diagnosed untreated cases of dermatophytosis attending the Dermatology outpatient of a tertiary care hospital, Mysore, constituted the material for the study. Specimens such as hair nail and skin scrapings were collected from suspected cases. Direct microscopy was done using potassium hydroxide preparation and culture was done on Saboraud’s dextrose agar and Dermatophyte test medium was done. Isolates were identified up to species level following conventional methods.72 samples from suspected cases of dermatophytosis were processed. Dermatophytes were isolated from 38 (52.77%) samples. Trichophyton rubrum was the commonest isolate 26 (36.11%). Male to female ratio was 2.3:1.21-40 years was the most common age group involved. Tinea corporis (22.22%) was the commonest clinical type of dermatophytosis.

Conclusion: The present study provided data regarding the etiological agents of dermatophytosis in this part of Karnataka. DTM is very useful as a screening medium and the isolation of dermatophytes is rapid when compared to SDA. Early diagnosis is essential to prevent transmission of infection.

Key words: Dermatophytes, Trichophyton, Tinea corporis, Dermatophyte test medium.

Citation

Title: Parenteral Organophosphate Poisoning Presenting With Seizure

Authors: Dr Bharath Juluganti, Dr K. Pradeep Reddy, Dr S.Balasubramaniyan

Paper Index: 10.2014-13545111

Abstract

Organophosphate (OP) poisoning is common in India. Only few case reports of parenteral OP poisoning have been described. We report a case of self-injected methyl parathion poisoning, presenting after four days with seizure, altered sensorium, and respiratory distress which posed a diagnostic and therapeutic dilemma. Despite nonavailability of history of OP poisoning, he was treated based on suspicion and showed a good clinical response to treatment trial with atropine and pralidoxime, and had a successful recovery. Atypical presentations may be encountered following parenteral administration of OP poison, and even a slight suspicion of this warrants proper investigations and treatment for a favorable outcome. Persistently low plasma cholinesterase level is a useful marker for making the diagnosis.

Citation

Title: A Prospective Study of Evaluation of Different Methods of Preoperative Hair Removal and their Relationship to Postoperative Wound Infection

Authors: Dr. Mukesh Kumar Gupta, Dr. Vinny Gupta, Dr. Kamal Kant

Paper Index: 10.2014-59418562

Abstract

INTRODUCTION - Wound site infections are a major source of postoperative illness, accounting for approximately a quarter of all nosocomial infections. The prevention of surgical site infections encompasses meticulous operative technique, timely administration of appropriate preoperative antibiotics, and a variety of preventive measures. As part of the antiseptic steps taken to reduce postoperative wound infection, different methods of hair removal are employed when preparing patients for operations.
OBJECTIVES - The present study was a prospective comprehensive study carried out on 1000 patients undergoing elective surgeries over a period of two years (2012 & 2013), in M. G. Hospital, Department of Surgery attached to Dr. S.N. Medical College , Jodhpur. This study aimed to evaluate the relationship of different methods of preoperative hair removal to postoperative wound infection.
METHODOLOGY - Consecutive consenting patients scheduled to have elective surgery (clean and clean contaminated) were randomized into four groups as per preoperative hair removal method used. Details of the procedures were recorded and patients were then assessed for postoperative wound infection.
RESULTS-In the present study overall rate of SSI was 19.40%. The maximum rate of SSI was found in razor group (28.25%) that is followed by clipper group 15%, cream group 13% and minimum rate of SSI was found in No Hair Removal group 8%. This difference in rate of SSI in different methods of Hair removal was statistically significant.

CONCLUSION- Hairs should not be removed preoperatively unless the hair at or around the incision site will interfere with the operation. If removal of hair is necessary then it should be done immediately before surgery, and preferably with clippers or cream.

Key words – surgical site infection, preoperative hair removal, clipper, razor

Citation

Title: To Evaluate the Antimicrobial Activity of Herbal Extracts and their Efficacy in Disinfecting Gutta Percha Cones Before Obturation- An in Vitro Study

Authors: Dr. Pratima. R Shenoi, Dr. Elakshi. S Morey, Dr. Chetana. Makade, Dr. Mohit.K. Gunwal, Dr. Sunay.S. Wanmali

Paper Index: 10.2014-25321392

Abstract

Context: Gutta percha are known to be contaminated during storage and intra operative manipulation. Chair side disinfection of these points is important and critical for success of endodontic therapy. Gutta percha being heat labile, chemical disinfection is the only viable alternative which takes longer time and may leave a residue.

Herbal gels are known to have antimicrobial , antiseptic properties and were not explored till date as an alternative pre operative disinfective medicament for gutta percha points. This paper focuses on use of Herbal gels for disinfection of Gutta percha points.

Aim: To evaluate Herbal extracts for their antimicrobial activity and their efficacy in disinfecting Gutta percha cones before obturation.

Materials And Methods: Concentrated extracts of Aloe vera, Neem bark and Turmeric were used to check for their antimicrobial efficacy using agar well diffusion method. Presence of inhibition zones were identified against three common gutta percha contaminants namely E-Coli, E-faecalis and Stap Aureus. Sodium hypochlorite (5.25%) and Saline (0.9%) were used as controls. Forty-five Gutta percha cones were contaminated by glove handling during root canal treatment and were cut into two equal halves by sterilized Gutta percha cutter. First half of all the samples were placed in the broth and incubated to ascertain and confirm that the gutta percha points are contaminated. The second part of each contaminated cone was then treated with the herbal gels for 3 minutes and then incubated in the broth. This was done to observe any inhibition in bacterial growth due to treatment with herbal gels.

Results:

1) Herbal gels are effective against E-coli, E-faecalis and Staph-aureus.

2) Gutta percha cones do get contaminated during storage and Root canal treatment due to glove handling.
3) Placing gutta percha points in herbal gels for 3 minutes effectively decontaminate them, with neem gel showing decontamination equivalent to sodium hypochlorite.

Conclusion: Herbal extracts which are known to be antiseptics in Naturopathy are indded effective as Gutta percha decontaminants. The Neem bark extract is as effective as 5.25% sodium hypochlorite within a minute and holds a promising future.

Key words: Aloe vera, disinfection, gutta percha cones, Neem bark, Turmeric.

Citation

Title: Application of Theory of Planned Behavior: Intension of Health Care Providers to Initiate Clients for Provider Initiated Counceling and Testing. A Case Study of Gedeo Zone, South Ethiopia

Authors: Yohannes Addisu, Akine Eshete, Prabhanjan Kumar Vata

Paper Index: 11.2014-27667168

Abstract

Ethiopia is among the countries most affected by HIV epidemic prevalence. In spite of arrangements made to advance HIV testing and related services, evidences suggest that many opportunities to diagnose individuals at health facilities are still missed because of lack of clients’ active seeking for HIV testing, refusal of testing offer and lack of active role of health care providers in initiating HIV testing. The objective of this study is to determine the behavioral intention of health care providers to initiate clients attending outpatient departments for PICT in Gedio Zone health facility. A facility based cross-sectional study design, supplemented with qualitative study was conducted on to identify Predictors of health care providers’ intention among health care provider who were working in outpatient department in Gedio Zone. The theory of planned behavior was used as a conceptual framework for the study. The present research identifies that the Health care provider of Gedio Zone has a high intention to do provider initiated HIV testing and counseling service and there is need to concerned create facilitating conditions to health care provider to realize their high intention of doing provider initiated HIV testing and counseling service into real practice.

Keywords-CDC, HCF, HCP, PICT, TPB, TRA, VCT

Citation

Title: Role of Resolvins in Periodontal Inflammation-A Review

Authors: Dr Shilpa Shetty, Dr Mranali K Shetty

Paper Index: 11.2014-42571671

Abstract

The discovery of resolvins has been a major breakthrough for understanding the processes involved in resolution of inflammation. Resolvins belong to a family of novel lipid mediators that possess dual anti-inflammatory and pro-resolution actions. When inflammation is initiated, goal of host response is to quickly return to homeostasis through rapid elimination of invading leucocytes. Resolution of inflammation is an active process. Cells and events are stimulated to respond, which is quite different from blocking pro-inflammatory pathways. Periodontitis is a chronic multifactorial disease. Various aspects of innate and acquired immunity play role in the pathogenesis of periodontitis. When an inflammatory event is initiated by bacteria, viruses or injury, the goal of the host response is to quickly return to homeostasis through rapid elimination of invading leukocytes. This review summarizes known signaling pathways utilized by resolvins to regulate inflammatory responses associated with the oral cavity.

Keywords: inflammation, resolvins, periodontitis

Citation

Title: Osteopetrosis A Rare Cause of Anemia - Case Report

Authors: Dr Ujjwala Keskar, Dr Sanjay Natu, Dr Manaskumar Behera

Paper Index: 11.2014-78878135

Abstract

Malignant Infantile Osteopetrosis (MIOP) is a rare genetic disorder due to abnormal osteoclast activity. We report a case of two year old girl, diagnosed as MIOP while investigating the cause of anemia with hepatosplenomegaly and hydrocephalus. Her medical history revealed non consanguineous parents. Systemic examination showed severe anemia, hepatosplenomegaly, growth failure, and rickets. Skeleton radiographs detected generalized dense bone. Cerebral CT scan revealed hydrocephalus. MIOP was suspected based on clinical, radiological and haematological findings. MIOP should be kept in mind as a rare cause of anemia. Early diagnosis and timely hematopoietic stem cell transplantation are the only curative approach for an otherwise fatal disease.

Keywords-Osteopetrosis,hepatosplenomegaly,hydrocephalus

Citation

Title: Socio-Demographic Correlates of Exclusive Breastfeeding Practices among Mothers in Abakaliki Metropolis

Authors: Ominyi, Jude Nweze, Nwodom, Maureen U.

Paper Index: 11.2014-75913825

Abstract

This study was carried out to examine the socio-demographic correlates of breastfeeding patterns among mothers in Abakaliki metropolis. The method of survey was adopted in which a simple random selection of four different market places from different locations around the metropolis of Abakaliki was done. The sample size for this study was in all 200. 200 of them were given questionnaires with all of them returned and analyzed. The findings show that the mean age of the respondents is 33 years with standard deviation of 8.43 and variance of 71. The practice of exclusive breastfeeding was found to be higher (44%-47%) among young mothers who had at least secondary education. While complementary/mixed feeding was high among mothers who had at most influence of socio-demographic factors on the patterns of breastfeeding. The study also revealed that there is high percentage contribution of the level of formal education to the determination of the patterns of breastfeeding among the respondents followed by that of occupation and then marital status. It is recommended that enlightenment campaign on the benefits of exclusive breast- feeding should be increased in within the area.

Citation

Title: Chronic Hyperplastic Candidiasis in a Child: A Rare Case Report and Literature Update

Authors: Dr. Asha M.L, Dr. Deepak P, Dr. Anupama Sattigeri, Dr. Jigna V Raja, Dr. Diksha Malhotra

Paper Index: 11.2014-36588732

Abstract

Chronic Hyperplastic candidiasisis a variant of candidiasis and in children it is a rare condition of oral mucosa.

Clinical Picture: -An11 year old girl presented with a history of white patch since fifteen days on dorsal surface of the tongue and it was not associated with any lesions on the skin or on any other oral mucosal sites. Histological pictures were consistent with candidal Hypae.

Treatment: -Only Topical Anti Fungal agents were given for one week twice daily for the lesion and along with that dental and gingival status were improved by conventional treatment procedures.

Result:-Complete elimination of the white patch was achieved along with the normal oral functioning.

Conclusion:-chronic hyperplastic candidiasis is a very rare type of oral candidiasis in children, early recognition and treatment is a must to prevent further complications.

Keywords: - chronic hyper plastic candidiasis, Anti-Fungal.

Citation

Title: Behavioural Pattern of Post-Mastectomy Patients Attending Radiotherapy Clinic at Ahmadu Bello University Teaching Hospital Zaria

Authors: Ominyi, Jude Nweze, Nwedu, Aaron B., Usman Ali, Chidobu Christian. C., Nwodom, Maureen U.

Paper Index: 11.2014-91735326

Abstract

This study explored the pattern of some of the behaviours of post-mastectomy patients attending the radiotherapy clinic at the Ahmadu Bello University Teaching Hospital, Zaria and factors influencing some selected behaviours were identified. Six-five post-mastectomy patients who gave their informed consent to participate in their study were purposively selected. Data were collected using a structured questionnaire, which had been tested for face validity and reliability. Data generated from the study were analysed using descriptive and inferential statistical procedures.

A negative pattern of behaviour was observed where behaviour involved in public religious, social and outdoor activities as well as sexual behaviour were concerned. However, family relationships and cosmetic behaviours improved. Majority (76.9%) of the women experienced emotional trauma, which resulted in them making positive efforts to improve their cosmetic outlook. Some of the cosmetic enhancing behaviours included the use of special accessories and protective dressing. This behaviour pattern was observed more among married than single women and those who went out to work. Family relationships were improved as most of them enjoyed a sustained or improved relationship with their children (96.9%), their husbands (80.0%), and readily accepted assistance with housework (69.2%). The emotional trauma experienced by these women was primarily responsible for the majority (72.3%) of them refusing with bathing and grooming. Many of them stopped attending parties whilst many (60.0%) had either excluded or reduced the frequency of outdoor activities e.g. games.

Sexual activities reduced among 41 out of 42 women of childbearing age and non-existent and the widows. Some women reduced the frequency of sex because they attributed the need for mastectomy to sex-related activities and therefore wanted to protect the other breast from disease. None had bilateral mastectomy. Peri-operative management showed that all women had skin care but only 22 (33.8%) were pre-operatively educated on the methods of improving their post-operative body image. Of those that were educated 13 (60.0%) had a positive perception of mastectomy.

Counselling on improving post-mastectomy body image using special brassieres, breast prostheses and breast reconstruction should be given to all patients and their husbands especially in the pre-operative period. These supportive measures should be made available and affordable to patients. Nurses caring for mastectomy patients should explore with each patient her fears and concerns regarding mastectomy, identify interpersonal and extra personal resources that will aid the patient’s rehabilitation into the society.

Key words: Mastectomy, body image, psychological distress, sexuality, breast reconstruction and cosmetics

Citation

Title: A Rare Case of Spindle Cell Sarcoma in a Pre-existing Neurofibromatosis- A Case Report

Authors: Sumegha Rana, Jitin Yadav, Babumani Baskey

Paper Index: 11.2014-15714799

Abstract

Aims & Objectives- A rare case report of a case of spindle cell sarcoma occurring in a known patient of neurofibromatosis.

Methods- A 35 year old female patient came with complaints of rapidly increasing pain and swelling of right upper limb below elbow, along with loss of movement in right hand. She had generalized multiple swellings in whole body for last 10 years suggestive of neurofibromatosis. On examination the swelling had involved whole of the forearm which was of variegated consistency, mostly hard, temperature was raised with no tenderness. FNAC was inconclusive as well as incisional biopsy. MRI of right upper limb was suggestive of neurofibroma/neurofibrosarcoma and excision was nearly impossible as tumour had involved whole circumference of the forearm.

Results & Conclusion- An above elbow amputation was done and tissue was sent for HPE which made the diagnosis of spindle cell sarcoma. This was curative treatment for the patient as she came for follow up after six months with no evidence of any recurrence and artificial limb was prescribed for a better quality of life.

Citation

Title: Comparative Study of Various Methods of Fetal Weight Estimation at Term Pregnancy

Authors: Dr Syeda Ayesha Siddiqua, Dr Deepthi, Dr Aarathi Bharath

Paper Index: 11.2014-35161396

Abstract

Aim: To assess the fetal weight in term pregnancies by various methods like Abdominal girth x Symphysiofundal height (Insler’s formula), Johnson’s formula and Hadlocks formula using USG.

Objective: To correlate these three methods of estimation of fetal weight with the actual birth weight of the baby after delivery.

Materials and Methods: The study was conducted in 100 women with full term pregnancy.These patients who were selected from antenatal clinics and maternity wards had their last fetal weight estimation done within one week of delivery. The study was conducted over a period of one year. Patients in whom delivery was anticipated within 1 week were included in this study and those who did not deliver within 1 week of fetal weight estimation were excluded from the study. The duration of gestation was calculated according to Naegale’s rule or by first trimester scan report. A comparative evaluation of fetal weight estimation in term pregnancy using Abdominal girth x Symphysio fundal height (Insler’s formula), Johnson’s, and Hadlock’s formula using ultrasonography was done. The fetal weight estimated by the above three methods was compared with actual weight of baby after birth. Data collected for age, parity, actual birth weight, mean birth weight by different methods was organized, interpreted and analyzed using appropriate statistical methods. P value of < 0.05 was considered significant.

Results: Results of the correlation analysis showed that there is a significant relationship between estimated and actual birth weight for all the methods. The major finding from this study is that ultrasonographic estimation of foetal weight is as accurate as the clinical method of estimation within the normal birth weight range.

Conclusion:Estimation of birth weight clearly has a role in management of labour and delivery in a term pregnancy. Of the three clinical formulae studied, USG

Key Words: Pre natal Fetal Weight, Ultrasonography, Birth weight, Estimated fetal weight, Actual Birth Weight

Citation

Title: Using Maggot Therapy In Treatment Of Wounds: A Review Of Its Effectiveness And Patients’ Experiences

Authors: David A. Agom. Joy D. Agom, Anyigor C.N

Paper Index: 11.2014-65985938

Abstract

Wound treatment is one of the major areas in medical and nursing practice that has attracted attention of health professionals because of the rising incidence of chronic wounds coupled with their numerous associated socioeconomic consequences to individuals and governments. The objective of this work was to investigate the effectiveness and patient’s experiences of maggot therapy in the treatment of wounds. A Systematic review of qualitative and quantitative research literature was adopted for this work. Seven electronic databases were systematically searched using relevant key words. A total of 17 articles which met the inclusion criteria were selected and critically appraised and analysed using CASP tool. Seventeen studies were reviewed to ascertain the effectiveness and patient’s experiences of maggot therapy. The findings for effectiveness of maggot therapy show that maggot therapy is better in wound debridement compared to conventional therapy. Patients treated with maggot therapy had varied experiences of pain, tingling sensation, loss of appetite, eerie feelings and itching. However, despite all these negative experiences, many patients remarked on speedy visible improvement on their ulcer wound and odour reduction. Besides, they considered maggot therapy acceptable and would recommend it to others. It could be concluded that maggot therapy is excellent in debriding chronic wounds and has greater potential to reduce healing time compared to conventional way of wound treatment.

Key words: maggot therapy, wounds, effectiveness, experiences.

Citation

Title: The Truth about Labial Adhesion

Authors: Mahalakshmi.T

Paper Index: 11.2014-62544487

Abstract

Labial adhesionsis a medical condition of the female genital anatomy where the labia minora become fused together. It is generally a pediatric condition.& occurs most frequently in younger pre-pubertal girls ages 3 months to 6 years .It is caused by something that has irritated the vaginal area. &patient may present with symptoms like dysuria, urinary frequency, refusal to urinate, or post-void dribbling.(riding a bicycle, teeter-totter, etc.). A Doctor will be able to diagnose labial adhesions by examination. Labial Adhesions in girls without symptoms therapy may not be needed, but with symptoms estrogen cream or ointment is usually the first medication chosen &this topical cream or ointment is most successful in resolving the adhesions.

Citation

Title: Melatonin Reduces Cardiac Injury Induced by Lipopolysaccharides in Rats

Authors: Ola M. Tork., Shaimaa N. Amin., Laila A.Rashed.

Paper Index: 11.2014-92317488

Abstract

Lipopolysaccharide (LPS) is known to cause inflammation and switch myocardial fuel similar to that of the failing heart: reduced mitochondrial substrate flux and myocyte lipid accumulation. The nuclear receptor: peroxisome proliferator activated receptor-alpha (PPARα) and PPAR-gamma coactivator-1alpha (PGC-1α) play important roles in transcriptional regulation of myocardial metabolism and may contribute to the changes that accompanied cardiomyopathic alterations in chronic inflammation. Melatonin is claimed to have anti-inflammatory activity in animal models. Our work was designed to assess the modulatory effect of melatonin on LPS-induced lipotoxic effect in heart of male albino rats for 6weeks. A systemic vehicle or LPS alone or combined with melatonin was administered. Serum cardiac enzymes, cardiac lipids and 3-nitrotyrosin (3-NT) and the gene expression of cardiac nuclear factor-kappa B (NF-κB), PPARα and PGC-1α were measured. Melatonin treatment showed a significant improvement of cardiac enzymes together with reduced cardiac lipid accumulation, 3-NT and NF-κβ and PPARα that paralleled enhancement of PGC-1α gene expression compared with the LPS rats.We conclude that cardioprotection of melatonin in chronic inflammatory condition is related to restoration of PGC-1α expression in addition to its antioxidant and anti-inflammatory capacity.

Keywords: Lipopolysaccharide, melatonin, 3-nitrotyrosin; peroxisome proliferator–activated receptor-γ coactivator-1α ; peroxisome proliferator activated receptor-alpha

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