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Cardiothoracic surgeries are life-saving procedures but often it results in various complications. Intraoperative cerebral oximetry monitoring used to detect regional cerebral oxygen saturation (rScO2) is a non-invasive method that provides prognostic importance in cardiac surgery. The main aim of the present study was to evaluate the association of intraoperative cerebral oxygen monitoring during cardiac surgery on postoperative complications. This was a case-controlled retrospective study conducted on adult patients, who underwent open-heart surgery in National Heart Institute, Malaysia. The case group comprised patients on protocolized cerebral oximetry monitoring. They were treated using a standardized algorithm to maintain rScO2 not lower than 20% of baseline rScO2. The control group comprised patients with matched demographic background, preoperative risk factors, and type of surgical procedures. Propensity score stratification was utilized to contend with selection bias. Retrospective analysis was performed on 240 patients (case group) while comparing it to 407 patients (control group). The non-availability of cerebral oximetry monitoring during surgery was the prominent predictor for all outcome of complications; stroke (OR: 7.66), renal failure needing dialysis (OR: 5.12) and mortality (OR: 20.51). Postoperative complications revealed that there were significant differences for risk of mortality (p

Germ cells are vulnerable to stress. Therefore, how organisms protect their future progeny from damage in a fluctuating environment is a fundamental question in biology. We show that in Caenorhabditis elegans, serotonin released by maternal neurons during stress ensures the viability and stress resilience of future offspring. Serotonin acts through a signal transduction pathway conserved between C. elegans and mammalian cells to enable the transcription factor HSF1 to alter chromatin in soon-to-be fertilized germ cells by recruiting the histone chaperone FACT, displacing histones, and initiating protective gene expression. Without serotonin release by maternal neurons, FACT is not recruited by HSF1 in germ cells, transcription occurs but is delayed, and progeny of stressed C. elegans mothers fail to complete development. These studies uncover a novel mechanism by which stress sensing by neurons is coupled to transcription response times of germ cells to protect future offspring.

Triggering of the big toe is an uncommon presentation. Here we present a case of a ballet dancer complaint of pain along the posteromedial aspect of the left ankle, associated with triggering of her big toe. To our knowledge, there have not been any reports on the above condition in our region. With changing of lifestyle and demand of the population, clinicians should be aware of this, therefore appropriate management and treatment can be given.

Peripheral muscle dysfunction in Overweight (OW) and Obesity (OB) leads to fatigue and activity limitations. However, there are contradictory views regarding the exact level with regard to hand grip and quadriceps muscle strength in OW and OB. The main objective of the present systematic review was to synthesize the literature for the strength part of the hand grip and quadriceps muscle strength among OW and OB. Literature search of Scopus, EBSCO and PubMed databases from 01.01.2004 to 30.06.2016, was performed. We set our search strategy using the terms “overweight OR obesity” AND “muscle strength” AND “grip OR quadriceps”. Two reviewers administered established eligible criteria and extracted the data. Strengthening the Reporting of Observational studies in Epidemiology (STROBE) was used to assess the risk of bias. Sixteen articles which were included identified Handgrip Strength (HGS), shoulder flexor, elbow flexor and knee extensor were found to be altered. There were consistent results with an increase in quadriceps muscle strength, whereas differed results were found in hand grip to increase and decrease in muscle strength in the presence of OW and OB. It is concluded that HGS appeared to be diversified with findings of increased and decrease strength, whereas regarding the quadriceps muscles, the findings were homogeneous.

Morgagni Hernia is a rare form of diaphragmatic hernia. It is mainly asymptomatic and often identified incidentally during surgery. Tension-free synthetic mesh repair is the preferred treatment modality. However, the use of synthetic mesh concurrently during a clean-contaminated surgery such as sleeve gastrectomy remains controversial due to the remote possibility of mesh infection. A middle-aged female 2 with BMI of 47 Kg/m was admitted electively for laparoscopic sleeve gastrectomy with concurrent umbilical hernia repair. Intra-operatively, a left Morgagni Hernia containing omentum and a segment of transverse colon was noted. She underwent a laparoscopic sleeve gastrectomy and simultaneous laparoscopic tension-free composite mesh repair of both Morgagni and umbilical hernia. Outpatient review three months later revealed excess weight loss of almost 30% with no recurrence of either hernia. In conclusion, the advantages of concurrent hernia repair during bariatric surgery outweigh the risk of mesh infection and should be performed to prevent future risk of visceral herniation and strangulation. Laparoscopic mesh repair of a Morgagni Hernia and umbilical hernia in the setting of an electively planned sleeve gastrectomy is feasible, effective and safe in the hands of a trained laparoscopic surgeon.

Paget-Schroetter syndrome is a form of upper limb deep venous thrombosis and it is commonly seen in young individuals. Paget-Schroetter syndrome is a rare condition and diagnosis becomes more difficult if it occurs in old individuals. There is no clear consensus regarding the exact treatment of Paget's Schroetter syndrome. A high grade of suspicion with early diagnosis and treatment is needed. We here describe the case of Paget-Schroetter syndrome in a 52-year-old male and discuss the important clinical features and treatment modalities.

Congenital pseudarthrosis of tibia is a rare condition and it is highly associated with neurofibromatosis. The goals of surgery are to restore the tibial alignment, achieve bone union and re-establish the length of the tibia. The treatment includes resection of the pseudarthrosis followed by fixation with external fixation devices to perform callus distraction, intramedullary nail or open reduction and plate fixation in combination with bone graft. We present a case of a 16-year-old male with underlying neurofibromatosis and congenital pseudarthrosis of right distal third of tibia. Patient was treated with excision of the pseudarthrosis followed by reduction and fixation using locking compression plate and bone graft. Radiograph showed union of the tibia at eight months postoperation. Patient had limb length discrepancy of 10 cm and was ambulating with a shoe raised. At two years follow-up, there was no refracture of the tibia. The patient was satisfied with his current functional status and had adapted well. Due to his good functional outcome, he declined to undergo limb lengthening surgery. We thereby concluded that locking compression plate may be considered as a suitable option for the treatment of congenital pseudarthrosis of tibia.

Myocardial Infarction (MI) is a major health problem worldwide. Animal models have been used extensively in scientific research. This was intended to help researchers to understand the underlying pathophysiology of MI, compensatory mechanisms involved and efficacy of treatment. Although, it is difficult to create necrosis similar to those found in human heart, various large and small animals were used to create experimental model of MI. Each of these animals and method of selection offers various advantages and disadvantages in relation to clinical studies. In the present review, we aim to highlight the different methods used to induce MI in experimental animals. These methods may be beneficial for academicians and researchers concerned with the treatment of MI.

Background: It is a common practice to heat cooking oil and reuse it in order to cut expenses. The use of repeatedly heated cooking oil predisposes to various cardiovascular diseases. Virgin coconut oil (VCO) is reported to possess antioxidant action. Aim: The study aimed to determine the effect of heating of VCO on the blood pressure (BP) and inflammatory bio-markers. Methods: Thirty male Sprague-Dawley rats were divided into five groups and were fed with the following diet for 24 weeks: normal rat chow (control); chow + fresh VCO (FVCO); chow + VCO heated once (1HVCO); chow + VCO heated five times (5HVCO) and chow + VCO heated ten times (10HVCO). BP was measured at baseline and four weekly for 24 weeks. Blood was collected at baseline and at the end of study to measure plasma TXB2, PGI2, VCAM-1, ICAM-1 and LDH enzyme activity. Results: BP increased significantly in the 5HVCO and 10HVCO groups compared to the control and FVCO groups. The 5HVCO and 10HVCO diet caused a significant increase in the plasma TXB2 and a significant decrease in the plasma PGI2 level. The plasma levels of VCAM-1, ICAM-1 and CRP were significantly increased in the 10HVCO group. Conclusion: Repeatedly heated VCO caused an elevation in the BP. The BP elevation was associated with a significant increase in the inflammatory bio-markers (VCAM-1, ICAM-1 and CRP), TXB2 and a significant reduction in the plasma PGI2 level.

Medical profession is one of the most coveted professions in the society. During the medical course, individuals are subjected to much stress and hardships. Many fail to cope up and quit the course or even land up in substance abuse. A major cause of concern is the health of any medico. On few occasion the disease may be imaginative in nature whereas at other times it may be actually present. There is a need to differentiate between two. At many occasions, there are illnesses which are a cause of worry for both parents and administration. The health of every single budding doctor is important as entrance to medical course is an intellectual superior individual it incurs heavy expenses on the part of the administration and we cannot afford to compromise on such a potential asset to the society. We performed an extensive search of literature such as Pubmed, Scopus and Google for obtaining necessary articles for this short narrative mini review. Search terms included: “medical”, students”, “illnesses”, disease.” The present review is first of its kind which aims to discuss the medical illness and various diseases affecting the medicos during their professional career. The results of the review may help in better planning in terms of taking care of the health of medical students

Langerhans cell histiocytosis (LCH), previously known as Histiocystosis X, is a rare idiopathic disease caused by a build-up of langerhan cells in the body. LCH has a heterogenous form of clinical presentation and presents with varying degree of severity. The severity often depends on the disease burden. LCH can manifest as a unifocal disease, multifocal-unisystem or multifocal-multisystem disease with the latter being more fatal than the rest. Risk organ involvement confers a grim prognosis. Perianal lesions are extremely rare skin manifestation of LCH with only few cases reported in the past. Vinca-alkaloids and steroid therapy have been shown to be effective in a large percentage of those presenting with LCH. This case report highlights the diagnosis and management of LCH presenting as a painful perianal ulcer in the background of newly diagnosed diabetes insipidus.

Small bowel obstruction is a common clinical problem presenting with abdominal distention, colicky pain, absolute constipation and bilious vomiting. There are numerous causes, most commonly attributed to an incarcerated hernia, adhesions or obstructing mass secondary to malignancy. Here we present an unusual cause of a small bowel obstruction secondary to an incarcerated incisional hernia in association with an acute organoaxial gastric volvulus.

A 67-year-old man of Chinese descent presented with a painless nodular lesion that had been present on his right forearm for the previous 3 months. A single, well-defined, dome-shaped, firm nodule with a central keratin plug surrounded by erythema was noted. Keratoacanthoma with secondary bacterial infection was suspected and the patient underwent an excision biopsy. Biopsy of the nodule and immunohistochemical staining supported a diagnosis of nodular malignant melanoma. It should be noted both that nodular malignant melanoma may present with a wide variety of clinical appearances, and that the lack of melanin pigment in nodular malignant melanoma may hinder the diagnosis of this aggressive tumour.

We present a 20-year-old Malay male whom we believe has Proteus syndrome, a rare congenital disorder of asymmetrical overgrowth of body tissues. There are fewer than 100 confirmed cases reported worldwide thus the clinical presentation and histopathological findings are of significance. Our patient presented with an overgrown right small finger and subcutaneous purplish pigmentation over his left upper arm and chest since birth. His small finger gradually increased in size. He had no abnormalities in sensation or power. Radiographs revealed a delta shaped middle phalanx of the small finger. His activities of daily living were uninterrupted but he requested debulking surgery for cosmetic reasons. Histopathological examination reported hypertrophic fatty tissue composed of well formed lobules of mature adipocytes interspersed with fibrous elements.

Dural metastasis is a rare entity in clinical practice. We report a case of dural metastasis secondary to thyroid carcinoma, which on both preoperative CT and MRI and at surgery had the typical appearance of a meningioma. Histopathological findings confirmed metastatic follicular thyroid carcinoma as a primary site. Although rare, dural metastases can mimic a meningioma. Our experience in this case has led us to consider metastasis as a differential diagnosis even when a meningioma is suspected. We believe that reporting of the case of dural metastasis mimicking a meningioma may help clinicians in future.

The description of accessory phrenic nerve (APN) in the standard textbooks and available literature is vague and sometimes limited to few lines. The incidence of APN varies a great deal from 17.6 % to 80.9 % in the available literature. The aim of the present study was to calculate the incidence and variation of APN in Indian population. Material and methods: Forty five adult formalin-fixed cadavers (35 male, 10 female; 90 sides) used for gross anatomy dissection for undergraduates; during the 2 year period 2006–2007 were considered. Findings were recorded at different stages of the dissection. Results: Out of 90 body sides studied, the APN was present in 48 sides (53.3 %). In 17 of the above sides the APN was confined to the cervical region (Cervical type) and in 31 sides the APN entered the thorax (Thoracic type), all anterior to the subclavian vein (SV). In eleven specimens the APN was found bilaterally. Conclusion: The incidence of APN, with its course and relation to the various structures in cervical and thoracic region will help the surgeons while performing internal thoracic artery (ITA) grafting and other radical neck surgery.

The superior transverse scapular ligament (STSL) bridges the suprascapular notch, converting it into a suprascapular foramen. The suprascapular nerves and the vessels traverse through the suprascapular foramen of the scapula. Often the STSL is ossified to produce compression of the suprascapular nerves producing resultant symptoms. The entrapment of the suprascapular nerve by the ossified STSL may result in symptoms like pain in the shoulder region and also result in wasting and weakness of the supraspinatus and infraspinatus muscles. Such a condition has to be differentiated from other conditions like rotator cuff tears. Often asymptomatic cases make the diagnosis difficult. The present study reports the anomalous ossified STSL detected in a bone specimen, discusses its anatomical and radiological aspects and describes its clinical implications.

The demographic profile of the Asian population is rapidly changing, with a fast increasing ageing population, owing to an increase in longevity and a decreasing birth rate. Moreover, due to improved medical facilities and the increased aged population, Alzheimer’s disease (AD) is fast emerging as a major health problem in many Asian countries. As curative treatment for AD is still elusive, care giving is an important component of the management of AD. While Western countries have recognised this issue, besides highly industrialized Japan, the Asian initiative has been relatively slow. This article aims to address issues involved in caregiving in AD in some Asian countries.

Discoid meniscus is the commonest anatomical aberration of the knee joint, among rare cases such as bilateral separated lateral meniscus, accessory lateral meniscus, partial deficiency of the lateral meniscus and double-layered lateral meniscus. An 11-year- old girl presented with history of chronic pain in her right knee for the last 6 months. The problem disturbed her involvement in the sport activities at school. Clinical examination revealed a clicking sensation on knee extension with lateral joint line tenderness. Magnetic resonance imaging (MRI) of her right knee showed torn posterior horn of lateral meniscus. Arthroscopy examination revealed a discoid meniscus with absence posterior horn. Posterior horn deficient discoid meniscus is a rare form of a congenital meniscus anomaly. We as clinicians believe that the abnormal shaped meniscus may pose a diagnostic challenge clinically and radiologically. Presentation of this case may be beneficial for orthopaedicians in their daily clinical practice.

Normally the ulnar artery and the ulnar nerve pass superficial to the flexor retinaculum of the wrist. In the present study, we describe an ulnar artery and ulnar nerve which passed deep to the flexor retinaculum and an absent superficial palmar arch. Abnormal course of ulnar nerve and ulnar artery passing deep to the flexor retinaculum with absence of a characteristic superficial palmar arch is a rare finding. The ulnar vessels and nerves when passing deep to the flexor retinaculum are vulnerable to compression and may be important for clinicians diagnosing compressive neuropathies and surgeons operating on the wrist.

The combination of rectus sternalis muscle, anomalous attachment of pectoralis minor muscle and supernumerary ribs in a single individual has not been reported by any research study, to the best of our knowledge. We report a left-sided rectus sternalis muscle, altered attachment pattern of the pectoralis minor muscle and the presence of a right-sided supernumerary rib in the third intercostal space of a 42-year-old male cadaver. Anatomical knowledge of rectus sternalis muscle may be important for radiologists who may misinterpret it to be a bulging mass in routine mammography and for surgeons performing reconstructive surgery. Variations of pectoralis minor muscle may influence the kinematics around the scapula and may be important for biomechanical studies. The shadow of the supernumerary rib may overlap and confuse radiologists interpreting roentgenograms. The aim of the study was to highlight the complex musculoskeletal defects and discuss their academic and clinical significance.

The coronary sinus normally opens into the right atrium through a single orifice. Past research studies have described various anomalies of the coronary sinus but there are fewer reports on multiple orifices of the coronary sinus. The present study reports two additional orifices of the coronary sinus opening into the right atrium and associated anomalous vessels. The presence of multiple orifices may be clinically important during any catheterization and cardiac surgeries and for proper interpretation of angiographic studies.

HYPK (Huntingtin Yeast Partner K) was originally identified by yeast two-hybrid assay as an interactor of Huntingtin, the protein mutated in Huntington's disease. HYPK was characterized earlier as an intrinsically unstructured protein having chaperone-like activity in vitro and in vivo. HYPK has the ability of reducing rate of aggregate formation and subsequent toxicity caused by mutant Huntingtin. Further investigation revealed that HYPK is involved in diverse cellular processes and required for normal functioning of cells. In this study we observed that hyperthermia increases HYPK expression in human and mouse cells in culture. Expression of exogenous Heat Shock Factor 1 (HSF1), upon heat treatment could induce HYPK expression, whereas HSF1 knockdown reduced endogenous as well as heat-induced HYPK expression. Putative HSF1-binding site present in the promoter of human HYPK gene was identified and validated by reporter assay. Chromatin immunoprecipitation revealed in vivo interaction of HSF1 and RNA polymerase II with HYPK promoter sequence. Additionally, acetylation of histone H4, a known epigenetic marker of inducible HSF1 binding, was observed in response to heat shock in HYPK gene promoter. Overexpression of HYPK inhibited cells from lethal heat-induced death whereas knockdown of HYPK made the cells susceptible to lethal heat shock-induced death. Apart from elevated temperature, HYPK was also upregulated by hypoxia and proteasome inhibition, two other forms of cellular stress. We concluded that chaperone-like protein HYPK is induced by cellular stress and under transcriptional regulation of HSF1.

Breast cancer estrogen receptor (ER) status is one of the strong additional factors in predicting response of patients towards hormonal treatment. The main aim of this study was to assess the morphological characteristics and proliferative activity using MIB-1(Ki-67) of estrogen receptor negative invasive breast ductal carcinoma (NOS type) as well as to correlate these features with clinicopathological data. We also aim to study the expression of c-erbB2 in ER negative breast tumors. High proliferative rate (MIB-1 above 20%) was observed in 63 (63.6%) of 99 ER negative tumors and that these tumors were associated with high expression of c-erbB2 (57.6%). We observed that MIB-1 is a reliable independent prognostic indicator for ER negative infiltrating ductal carcinoma in this study.

This review is to examine the current literatures on the relationship between periodontitis and hypertension as well as to explore the possible biological pathways underlying the linkage between these health conditions. Hypertension is one of the major risk factors for cardiovascular diseases. Oxidative stress and endothelial dysfunction are among the critical components in the development of hypertension. Inflammation has received much attention recently and may contribute to a pivotal role in hypertension. Periodontitis, a chronic low-grade inflammation of gingival tissue, has been linked to endothelial dysfunction, with blood pressure elevation and increased mortality risk in hypertensive patients. Inflammatory biomarkers are increased in hypertensive patients with periodontitis. Over the years, various researches have been performed to evaluate the involvement of periodontitis in the initiation and progression of hypertension. Many cross-sectional studies documented an association between hypertension and periodontitis. However, more well-designed prospective population trials need to be carried out to ascertain the role of periodontitis in hypertension.

BACKGROUND: Exercise training programs have emerged as a useful therapeutic regimen for the management of type 2 diabetes mellitus (T2DM). Majority of the Western studies highlighted the effective role of exercise in T2DM. Therefore, the main aim was to focus on the extent, type of exercise and its clinical significance in T2DM in order to educate the clinicians from developing countries, especially in Asians. METHODS: Pubmed, Science Direct, Scopus, ISI Web of Knowledge and Google scholar were searched using the terms "type 2 diabetes mellitus," "type 2 DM," "exercise," and/or "physical activity," and "type 2 diabetes mellitus with exercise." Only clinical or human studies published in English language between 2000 and 2012 were included. Certain criteria were assigned to achieve appropriate results. RESULTS: Twenty five studies met the selected criteria. The majority of the studies were randomized controlled trial study design (65%). Most of the aerobic exercise based studies showed a beneficial effect in T2DM. Resistance exercise also proved to have positive effect on T2DM patients. Minimal studies related to other types of exercises such as yoga classes, joba riding and endurance-type exercise were found. On the other hand, United States of America (USA) showed strong interest of exercise management towards T2DM. CONCLUSION: Aerobic exercise is more common in clinical practice compared to resistance exercise in managing T2DM. Treatment of T2DM with exercise training showed promising role in USA. A large number of researches are mandatory in the developing countries for incorporating exercise in the effective management of T2DM.