International Medical Journal

Totally implantable access ports (TIAPs) are generally used in oncology patients. A total of 89 consecutive oncology patients, between 2016 to 2019 were enrolled to receive TIAP inserts via an internal jugular vein (IJV) or subclavian vein (SV). Data of early/late complications were prospectively collected. The exclusion criteria were having an active infection and coagulopathy (platelets count < 50 000/µl, INR > 2 or prothrombin time > 18s) at the time of CVAP insertion. For all the patients 8 French ports were used as CVAP and patients were randomly divided into 2 groups of CVAP venous puncture site: Subclavian or Internal jugular vein. Thirty-two patients (36%) were male and 57 (64%) were female. The median age of participants was 55. Chemotherapy ports were implanted through Subclavian and jugular vein in 47(52.8%) and 42 (47.2%) patients respectively. No differences were found in early and late complication rates. In conclusion, we observed that both implantation approaches were feasible and safe. If the circumstances do not permit a puncture of the jugular vein, or if the jugular vein should be preserved for central venous lines, a fluoroscopy-guided or also sonographically guided puncture of the subclavian vein can be a safe alternative.

Ankle fracture is one of the most common injury encountered by orthopedic surgeon. It can be resulted by simple twisting injury of ankle and also in high energy trauma from motor-vehicles accident. Concomitant tibio-talar dislocation following ankle fracture have been reported as many as 21% to 36% of ankle fractures and warrant early intervention and usually is associated with deltoid ligaments injury. However, until now the management of ankle fracture dislocation associated with deltoid ligament injury is still in debate. We report a case of 23 years old gentleman who involved in a motor-vehicle accident and sustained right lateral malleolus fracture with ankle dislocation. He underwent a close manual reduction (CMR) but failed as the post CMR X-ray shown that the ankle remains subluxated. Subsequently proceeded with plating of right fibula and deltoid ligaments repair using anchor sutures. Patient outcomes were reassessed with American Orthopedic Foot and Ankle score (AOFAS) at three months and six months’ post-operative and the result were 81% and 95% respectively.

Fructose accounts for 25% of sugar intake. The prevalence of obesity in the U.S. has also increased. High fructose diet leads to hepatic steatosis. Intestinal microbiota influences obesity. The aim of this review article is to elucidate the pathogenesis of obesity in fructose induced non-alcoholic fatty liver disease. The study included 42 articles published in the last 20 years searched in Pubmed, EMBASE, Cochrane library, Pubmed Central, Uptodate and Medline. Review articles were 14, original research articles involving human beings and animals were 16 and 12 respectively. This article did not require ethics approval. Fructose poses high risk for hepatic steatosis. Endotoxemia increased intestinal permeability. Altered lipid and amino acid metabolism lead to liver injury aggravated by dietary low copper. Fructose induced dysbiosis leading to fatty liver. Probiotics and preobiotics have an impact on the gut microbiota; thus improving liver function and decreasing obesity.

A surgeon is most likely to encounter major salivary gland diseases because of inflammation, stones, tumours or trauma in his practice with variability in clinical presentation. In this study includes the incidence, clinical presentation, surgical management, post-operative complications, correlation of USG and FNAC of salivary gland swellings with histopathology was done. To evaluate incidence according to age and gender distribution, accuracy of USG and FNAC in diagnosis and current surgical management of salivary gland swellings. This prospective observational case series of 25 patients studied over a period of 2 years presented with salivary gland swellings in our institution who are willing for Investigation and treatment. The case history, diagnosis with pre-operative USG, FNAC with post-operative histopathological correlation and surgical management and complications were assessed. Patients were aged between 4-65 years with presentational mean age of 37.2 years with male to female ratio of 3:2. Parotid gland is most common salivary gland involved of 21 cases. Most are of neoplastic origin with pleomorphic adenoma as commonest. 3 cases were misdiagnosed on USG in comparison with FNAC & histopathology with diagnostic accuracy of USG as 92%, while 100% diagnostic accuracy of FNAC observed in comparing with histopathology reports. Superficial parotidectomy was the most common surgery performed of 19 cases. Comparing to USG, FNAC is best helpful in diagnosis but histopathology is the gold standard. Salivary gland excision was the best surgical approach towards pathology of salivary gland swellings.

We presented a clinical case of a patient with newly diagnosed diabetes mellitus, during the disease COVID-19, confirmed by laboratory instrumental studies (PCR, computed tomography). Concern is the fact that it is in these patients with the syndrome of hyperglycemia or newly diagnosed diabetes in the background COVID-19, it is very difficult runs the clinic and a high probability of mortality. Indeed, in view of the short period of time since the beginning of the pandemic, there is no detailed study of statistical data and developments in their introduction, and therefore presents some difficulties in the tactics of their treatment. However, against the background of therapy, the patient showed positive dynamics, in the form of partial regression, a decrease in the intensity of interstitial infiltration of the lung tissue with a partial outcome in fibrosis.