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   Table of Contents - Current issue
Coverpage
April-June 2018
Volume 8 | Issue 2
Page Nos. 41-66

Online since Friday, April 6, 2018

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ORIGINAL ARTICLES  

Visual versus fully automated assessment of left ventricular ejection fraction Highly accessed article p. 41
Rami Mahmood Abazid, Samah I Abohamr, Osama A Smettei, Mohammed S Qasem, Annie R Suresh, Mohammad F Al Harb, Abdulrahman N Aljaber, Athary A Al Motairy, Diana E Albiela, Bashayer Muhil Almutairi, Haitham Sakr
DOI:10.4103/ajm.AJM_209_17  PMID:29682476
Introduction: The aim of this study is to compare three different echocardiographic methods commonly used in the assessment of left ventricle (LV) ejection fraction (EF). Methods: All patients underwent full echocardiography including LVEF assessed using M-mode, automated EF (Auto-EF), and visual estimation by two readers. Results: We enrolled 268 patients. Auto-EF measurement was feasible in 240 (89.5%) patients. The averaged LVEF was (52% ± 12) with the visual assessment, (51% ± 11) with Auto-EF and (57% ± 13) with M-mode. Using Bland-Altman analysis, we found that the difference between the mean visual and the Auto-EF was not significant (−0.3% [−0.5803–0.0053], P = 0.054). However, the mean EF was significantly different when comparing visual versus M-mode and Auto-EF versus M-mode with the mean differences: (−2.4365 [−2.9946–−1.8783], P < 0.0001) and (−2.1490 [−2.7348–−1.5631], P < 0.0001) respectively. Inter-observer variability analysis of the visual EF assessment between the two readers showed that intraclass correlation coefficient was 0.953, (95% confidence interval: 0.939–0.965, P < 0.0001), with excellent correlation between the two readers: R = 0.911, P < 0.0001). Conclusion: The two-dimensional echocardiographic methods using Biplane Auto-EF or visual assessment were significantly comparable, whereas M-mode results in an overestimation of the LVEF.
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Identification of extended spectrum beta lactamases, AmpC and carbapenemase production among isolates of Escherichia coli in North Indian tertiary care centre p. 46
Uma Chaudhary, Shipra Agarwal, Kausalya Raghuraman
DOI:10.4103/ajm.AJM_156_17  PMID:29682477
Introduction: Identification of Extended spectrum beta lactamases (ESBL), AmpC production and carbapenemase production among isolates of Escherichia coli, helps clinician to rationalize the choice of antibiotics. However, there is a lack of simple and effective method for simultaneous identification of these beta lactamases. Aim: To determine the concurrent production of beta lactamases using twelve disc method on E. coli isolates. Materials and Methods: A total of 200 multidrug resistant E. coli were screened using twelve disc method. The isolates of ESBL were confirmed by ceftazidime/clavulanic acid and cefotaxime/clavulanic acid method. Metallo-beta-lactamases (MBL) were confirmed by imipenem EDTA combined disc method. Results: Among the 200 isolates, 42.5% were ESBL producers, 9% were MBL and 6.5% were Klebsiella pneumoniae carbapenemase (KPC) and AmpC each respectively. Coproduction was seen in 54 (27%). A significant difference in sensitivity was seen in cefuroxime, aztreonam, cefoxitin and ceftriaxone among inpatient and outpatients. Conclusion: The present study highlights burden of ESBL, AmpC, KPC and MBL along with their coproduction in a tertiary care hospital. In-house antibiotic policy, infection control and epidemiological surveys will help us in controlling these resistant bugs. We believe, the twelve disc method is a simple, inexpensive screening method for beta lactamase production.
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BRIEF REPORT Top

Significance of bacteriuria in patients with end-stage renal disease on hemodialysis p. 51
Ibrahim Taweel, Norman Beatty, Alexsis Duarte, David Nix, Kathryn Matthias, Mayar Al Mohajer
DOI:10.4103/ajm.AJM_199_17  PMID:29682478
The significance of bacteriuria in patients with end-stage renal disease (ESRD) on hemodialysis (HD) is unclear. It is not known whether treatment of asymptomatic bacteriuria is associated with lower rates of urinary tract infection or readmission. Adult patients with ESRD on HD were retrospectively evaluated to assess factors associated with the recurrence of bacteriuria and readmission. We included 68 patients in the analysis. There were 20 patients (29.4%) with urinary symptoms. All symptomatic patients received antibiotic therapy, whereas half of the asymptomatic patients received antibiotics. Antibiotic use was not associated with lower rates of readmission or the recurrence of bacteriuria.
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CASE REPORTS Top

Submandibular lipoblastoma: Case report of a rare tumor in childhood p. 55
Olfa El Amine, Meyssa Belghith, Hasna Salhi, Aida Goucha, Amor Gamoudi
DOI:10.4103/ajm.AJM_81_17  PMID:29682479
Lipoblastoma is a rare, benign tumor usually occurring in childhood. It is essentially localized in the extremities and trunk, with few cases reported in the neck. We report the case of a 2-year-old girl with a rapidly enlarging, painless neck mass. Magnetic resonance imaging (MRI) revealed a 3-cm mass in the right submandibular region. Review of literature, diagnostic methods, and genetics of lipomatous tumors are discussed. Complete surgical excision via a lateral cervical approach demonstrated a white soft tissue with an adherent ganglion. Histology and immunohistochemistry confirmed the diagnosis of lipoblastoma. Cervical lipoblastoma is rare, and typically asymptomatic, rarely causing nerve compression or airway obstruction. MRI can help identifying the lipomatous nature of the mass, but the findings can be inconsistent due to variable maturity of fat cells and the mesenchymal content of the tumor. Diagnosis is always based on pathological examination. Further chromosomal analysis is useful in differentiating lipoblastoma from liposarcoma. Complete surgical excision is the recommended treatment.
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CD4-positive lymphoepithelial-like carcinoma: Report of unusual case p. 58
Luaay Aziz, Raya Saab, Toufic Eid, Mousa A Al-Abbadi
DOI:10.4103/ajm.AJM_135_17  PMID:29682480
We are reporting an unusual case of lymphoepithelial-like carcinoma (LELC) in an 8-year-old female patient where the tumor cells showed unusual CD4 expression. The lesion was found in the left submandibular neck region, in the vicinity of the submandibular gland. The salivary gland was not infiltrated by the tumor, and the tumor exhibited a classic LELC with single and clusters of tumor cells surrounded by many hematolymphoid cells. The tumor cells revealed strong positivity for Epstein–Bar virus as confirmed by the EBER: Epstein-Barr Virus in situ hybridization (EBER-ISH) method of staining. Interestingly, the tumor cells expressed membranous immunostaining for the T-helper lymphocyte antibody (CD4) in addition to pan-cytokeratin. A brief discussion about this unusual finding is offered. The patient was treated as a case of Epstein–Bar virus-associated nasopharyngeal carcinoma with excellent response.
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LETTERS TO THE EDITOR Top

Modified three-stitch hernioplasty technique p. 63
Charalampos Kokkinos, Georgios Anagnostopoulos, Dimitrios Filippou, Panagiotis Skandalakis
DOI:10.4103/ajm.AJM_160_17  PMID:29682481
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Hypertension management in older adults p. 65
Ahmad Alsarah, Osama Alsara, Ghassan Bachuwa
DOI:10.4103/ajm.AJM_194_17  PMID:29682482
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