INTRODUCTION: Renal colic pain is a very severe pain usually being consulted at the emergency room.New pain relievers together with combination of other drugs is used for symptomatic relief. Thisstudy compared the efficacy and tolerability of Diclofenac versus Dexketoprofen with Hyoscine N-butyl bromide (HNBB) in the management of acute renal colic at the emergency room. METHODOLOGY: This was a single blind, randomized prospective study done from June 1, 2017 toAugust 31, 2017 at the emergency department of the Jose Reyes Memorial Medical Center. Allocationand randomization were done into two treatment groups: the Diclofenac and Dexketoprofen + HNBB.Subjectivity of pain relief was based using visual analogue score (VAS), this was taken before thetreatment and 15, 30 and 60 minutes after administration of treatment. RESULTS: Twenty nine (29) patients were grouped into two: Dicloenac group (n=15) and Dexketoprophen+ HNBB group (n= 14). Pain reduction in the combination group had a faster pain relief compared toDiclofenac alone with a 41% and 17% decline, respectively. The study showed that a faster pain reliefwas achieved with the Dexkoprophen + HNBB combination compared to Diclofenac alone. CONCLUSION Timing and onset of pain control in patients presenting with renal colic pain is essentialin the emergency room setting to provide adequate relief. The use of the combination therapy ofDexkotoprofen + HNNB may have a significant advantage in terms of rapid onset of relief.

OBJECTIVE: Image-guided targeted biopsy techniques have been proposed to address problems ofsystematic transrectal ultrasound guided prostate biopsies that lead to the suboptimal cancer detectionrate as well as inaccurate grading of the disease. This study aims to provide local data on the diagnosticaccuracy of multiparametric MRI (MP-MRI) and MP-MRI ultrasound cognitive fusion biopsy inidentifying areas of clinically significant malignancy of the prostate. MATERIALS AND METHODS: This is a validity study involving patients who underwent MP-MRI and MP-MRI ultrasound cognitive fusion biopsy, who eventually underwent robot-assisted laparoscopic radicalprostatectomy (RALRP). Outcome measures included sensitivity, specificity, positive and negativepredictive values of MP-MRI and MP-MRI ultrasound cognitive fusion biopsy. Reference standardused was the final histopathologic report obtained after RALRP. RESULTS: MP-MRI has a sensitivity of 35.5%, specificity of 95.2%, positive predictive value of 97.1%,and negative predictive value of 25%. MP-MRI ultrasound fusion biopsy had similar results, withsensitivity of 34.4%, specificity of 81.0%, positive predictive value of 88.9%, and negative predictivevalue of 21.8%. CONCLUSION The high specificity and positive predictive value of MP-MRI (95.2% and 97.1%respectively) indicates the necessity for a prostate biopsy and supports the utility of a targeted MP-MRI guided ultrasound cognitive fusion biopsy. However, the low sensitivity and negative predictivevalue (25% and 35% respectively) of 35.5% indicates that MP-MRI guidance does not limit thenumber of biopsy samples only to visible MP-MRI lesions, since negative areas on MP-MRI stillcontains tumors in 75% of cases.

Human ; Adult ; GLAUCOMA-OPEN-ANGLE ; GLAUCOMA,SIMPLEX ; GLAUCOMA, COMPENSATED ; IRIDOCORNEAL ENDOTHELIAL SYNDROME ; FILTERING SURGERY ; GLAUCOMA ; SCLEROSTOMY ; TRABECULECTOMY

PURPOSE:To determine the cup and disc areas using computer-aided imaging. METHODOLOGY:Case-control study using the computer-aided imaging as a screening test in a given population. RESULTS:There is a wide variability in cup and disc areas among glaucoma suspects and normal. CONCLUSION:C:D alone has a poor predictive value for diagnosing glaucoma.Optic disc size with C:D is just as sensitive and specific in screening for glaucoma.Cup and disc areas are positively correlated for normal and glaucoma suspects.
Human ; Aged ; Middle Aged ; Adult ; GLAUCOMA

STUDY DESIGN: Retrospective chart review. PURPOSE: To evaluate the incidence of potential total disc replacement (TDR) candidates among cervical and lumbar fusion patient populations using strict Food and Drug Administration (FDA) criteria and with relative exclusion criteria removed. OVERVIEW OF LITERATURE: Recent studies suggest that the potential percentage of patients that are candidates for TDR ranges from 0-5% in lumbar fusions and 43% in cervical fusions. METHODS: We performed a retrospective chart review of 280 consecutive patients who had lumbar (n = 174) and cervical (n = 106) fusion or TDR performed by one of four independent adult orthopaedic spine surgeons. Charts were screened for investigational device exemption (IDE) inclusion/exclusion criteria and later reanalyzed excluding relative exclusion criteria, such as history of chronic medical illness, twolevel disease (cervical cases), and history of prior fusion surgery in the anatomic region. RESULTS: Of the 174 lumbar surgeries, 10 were TDR with Prodisc-L and 164 were lumbar fusions. The most common TDR exclusion criteria were lytic spondylolisthesis or spinal stenosis (47.7% of patients) and more than 2 level degenerative disc disease (37.9%). 14.9% had no IDE exclusion criteria and would be considered candidates for TDR. After excluding the relative lumbar exclusion criteria, this percentage increased to 25.8%. Of the 106 cervical cases, 3 had a TDR with Prodisc-C and 103 had a cervical fusion. Twenty eight percent had no IDE exclusion criteria and would be considered candidates for cervical TDR. CONCLUSIONS: A larger percentage of cervical fusion candidates are potential candidates for TDR (28%) than lumbar fusion candidates (14.9%) based on the strict IDE criteria.
Adult ; Humans ; Incidence ; Retrospective Studies ; Spinal Stenosis ; Spine ; Spondylolisthesis ; Total Disc Replacement ; United States Food and Drug Administration

Neurocysticercosis is thought to be the most common helminthic infection of the central nervous system and its epidemiology is changing due to increasing travel and migration. Evidence to guide management of the intraventricular form is limited. We aimed to review the clinical presentation, diagnosis and treatment of intraventricular neurocysticercosis with reference to two recent cases seen at our institution. The intraventricular variant of neurocysticercosis is less common than parenchymal disease and usually presents with acutely raised intracranial pressure and untreated it progresses rapidly with high mortality. The diagnosis is based on imaging and serological tests but more invasive testing including histopathological examination of surgically acquired tissue specimens is sometimes required. Treatment is mainly surgical, using a neuroendoscopic approach if possible. Patients should also receive antihelmintic treatment with concomitant corticosteroids to reduce the incidence of shunt failure if a ventricular shunt is inserted and to treat viable lesions elsewhere.

During a forensic entomological study conducted at an oil palm plantation in Tanjung Sepat, Kuala Langat, Selangor, a Bengalia emarginata Malloch, 1927 (Diptera: Calliphoridae: Calliphorinae: Bengalini) was collected for the first time. Two adults were collected nearby the pig carcass by the first author and identified by the second. Prior to this finding, nine species of Bengalia were recorded from peninsular Malaysia or Borneo. Male of B. emarginata are different from Bengalia varicolor Fabricious by the following characters: Sternite 5 projection rounded with small identation and mid tibia double-fringed in ventral surface.
Calliphoridae ; Malaysia ; Diptera ; Upper case Bee ; Status pre-

Fannia prisca Stein, 1918 is newly recorded from peninsular Malaysia. This record is based on 4 male specimens from Mount Berembun, Brinchang, Cameron Highland, Pahang state, peninsular Malaysia. It is previously recorded from China, Mongolia, Korea, Japan, Taiwan, Bonin Island, Thailand and oriental region. The male of Fannia prisca can be differentiated from male Fannia scalaris by the following features: for F. prisca, mid-coxa without spine; mid-tibia normal or without stout triangular ventral projection; and hind tibia usually with 2 av, while F. scalaris has several stout hook-like spines on the anterior margin; mid-tibia with stout triangular ventral projection and hind tibia usually with 3 av. Both F. prisca and F. scalaris can be differentiated from Fannia leucosticta by looking at its hind tibia, which only has 1 av.
Tibia ; Fannia ; Upper case eff ; Malaysia ; Stout

BACKGROUND: The depth of graft harvest and the residual dermis available for reepithelization primarily influence the healing of split-skin graft donor sites. When the thigh region is chosen, the authors hypothesize based on thickness measurements that the anterolateral region is the optimal donor site. METHODS: Full-thickness skin specimens were sampled from the anteromedial, anterior, and anterolateral regions of human cadavers. Skin specimens were cut perpendicularly with a custom-made precision apparatus to avoid the overestimation of thickness measurements. The combined epidermal and dermal thicknesses (overall skin thickness) were measured using a digital calliper. The specimens were histologically stained to visualize their basement membrane, and microscopy images were captured. Since the epidermal thickness varies across the specimen, a stereological method was used to eliminate observer bias. RESULTS: Epidermal thickness represented 2.5% to 9.9% of the overall skin thickness. There was a significant difference in epidermal thickness from one region to another (P<0.05). The anterolateral thigh region had the most consistent and highest mean epidermal thickness (60+/-3.2 microm). We observed that overall skin thickness increased laterally from the anteromedial region to the anterior and anterolateral regions of the thigh. The overall skin thickness measured 1,032+/-435 microm in the anteromedial region compared to 1,220+/-257 microm in the anterolateral region. CONCLUSIONS: Based on skin thickness measurements, the anterolateral thigh had the thickest epidermal and dermal layers. We suggest that the anterolateral thigh region is the optimal donor site for split-skin graft harvests from the thigh.
Basement Membrane ; Cadaver* ; Dermatologic Surgical Procedures ; Dermis ; Humans ; Microscopy ; Observer Variation ; Photomicrography ; Skin* ; Thigh* ; Tissue Donors* ; Transplants*

INTRODUCTIONPrevious studies revealed fewer visits for congestive heart failure (CHF) to emergency departments (EDs) in New Jersey, USA and fewer admissions for CHF to a Southern Indian and an Israeli hospital during warmer months. Using hospital admission rate for CHF as a marker for illness severity, we hypothesized that CHF would also be less severe in warmer months.

MATERIALS AND METHODSThis is a retrospective cohort study which included all ED visits from 1 January 2004 to 31 January 2006. We analysed the monthly CHF hospital admission rates. We a priori chose to compare the admission rates for the 4 warmest to the 4 coldest months.

RESULTSOf a total of 136,347 ED visits, 1083 (0.8%) were accounted for CHF. Hospital admission rate was 55.8%. Although there was a statistically significant increase in ED visits for CHF during the colder months, the 4 warmer months from June to September had 1.15 times higher hospital admission rate than the 4 coldest months from November to February.

CONCLUSIONSContrary to our hypothesis, we found a statistically significant increase in the percentage of CHF visits admitted to the hospital during the warmer months. This suggests that although there are less ED CHF visits in the warmer months, a greater percentage tend to be severe.

Aged ; Cohort Studies ; Emergency Service, Hospital ; Female ; Heart Failure ; epidemiology ; Hot Temperature ; Humans ; Male ; Retrospective Studies ; Seasons ; Severity of Illness Index