Background and objectives: The successful execution of dual task situations depends on many factors and is affected by physiological degenerative processes. The completion of a secondary task while walking can be considered as key contributor for falls in the elderly. The aim of the study was to investigate the impact of dual task performance on gait parameters, fear of fall among different age groups of elderly.Methods: Sixty elderly subjects with independent gait were evaluated while doing simple walking and dual task walking with cognitive, motor and cognitive motor gait demand in the study. The gait parameters namely time, speed and cadence were assessed using 10 meter walk test. Followed by every task, fear of fall was assessed using visual analog scale-fear of fall.Results: All the groups showed statistically significant difference in the gait parameters with addition of dual tasks. There was statistically significant difference among groups for number of step, time, speed and fear of fall (p value <0.01) for both simple and dual task. The mean dual task cost was highest in the dual task with cognitivemotor demand (49.35 ±0.418). Conclusion:The findings of the present study suggest that under dual task demand, elderly population shows greater variability of gait and increase in fear of fall. The deficits in dual task walking increases proportionally with age.
Background: Spinal arteriovenous metameric syndrome (SAMS), also known as Cobb syndrome is a rare metameric developmental disorder presenting as an extradural-intradural vascular malformation that involves bone, muscle, skin, spinal cord, and nerve roots.Case Report: An 11-year-old girl presented with history of progressive paraparesis, lower extremity sensory loss, along with bowel and bladder incontinence who was diagnosed with Cobb syndrome. She underwent endovascular embolization of one arterial feeder and two metameric components. Post embolization patient experienced further decline in muscle strength. Physiotherapy regimen was implemented for 4-5 days per week for period of two months. The patient was discharged with a home exercise programme.Result: At the time of discharge, muscle power was improved. Patient was able to walk with the help of walker. Conclusion:Spinal metameric arteriovenous syndrome is a complex nonhereditary genetic vascular disorder associated with variety of neurologic deficits. Physiotherapy management will play a major role in minimizing disability hence improve clinical outcome.
Choristoma is a tumor like mass which is an ectopic rest of normal tissue due to embryological developmental defect. The presence of choristoma in tonsil is extremely rare. On histopathological examination, mature hyaline cartilage were found surrounded by lymphoid follicles. We present a case of cartilaginous choristoma with the complaint of recurrent tonsillitis.
Introduction: Gestational trophoblastic diseases, because of their diverse presentation and the malignant lesions being associated with recurrence, metastasis, and mortality, early diagnosis is important with the help of ultrasonogram preoperatively, serial Beta human chorionic gonadotropin, and histopathological examination for prompt treatment and timely management of the patients. The study aimed to identify the overall prevalence and relative frequencies of Gestational trophoblastic diseases and to assess the association of different gestational trophoblastic diseases with maternal age, parity, and gestational age.Materials and Methods: This is a retrospective cross-sectional study conducted for five years from January 2016 to December 2020 in the Department of Pathology, and Department of gynecology and obstetrics of Dhulikhel Hospital, Kavre Nepal. This study included a spectrum of gestational trophoblastic diseases. All the details were obtained from the patient’s record file and register book. Results: Out of 65 cases, the most common was Hydatidiform mole with 59 (90.78%) cases. Bleeding per vagina was the most common clinical presentation. The most commonly affected age group was 21-25 years. Most of the gestational trophoblastic diseases were detected in the first trimester and primigravida.Conclusions: Any pregnant woman presenting with abnormal uterine bleeding should be evaluated for the presence of underlying Gestational trophoblastic disease. Beta-hCG is a sensitive marker, however, histopathology remains a gold standard modality for the detection of gestational trophoblastic diseases. The judicious use of ultrasonograms and appropriate clinicopathological approach helps the clinician to decide the treatment modalities, especially between evacuation and hysterectomy.
Introduction: Soft tissue tumors (STTs) are a diverse group of neoplasms. It varies from the most common benign tumors to some self-limited lesions and rare malignant soft tissue tumors. Because of the overlap in their clinical and radiological characteristics, histopathology is crucial in determining their diagnosis. Objectives: To study the relative frequencies of types of soft tissue tumors (benign, intermediate and malignant) as well as their histological pattern in relation to age, gender and site of distribution. Methodology: This was a retrospective study conducted over a period of three years from January 2018 to December 2020 in the Department of Pathology, Dhulikhel Hospital, Kavre Nepal. This study included STTs of all the anatomical sites excluding STTs of the female reproductive system. The tumors were classified as benign, intermediate, or malignant using the WHO 2013 classification of soft tissue and bone tumors. The sarcomas were further graded into grades 1, 2, and 3 using the FNCLCC (French Federation Nationale des Centres de Lutte Contre le Cancer) grading system. Immunohistochemistry (IHC) and special staining procedures were also performed as and when required. Result: A total of 198 STTs were studied, of which benign cases were 191 (96.45%), intermediate 03 (1.52%) and malignant 04 (2.03%) in number. The most common type of STTs was vascular tumors 77(38.89%) followed by adipocytic tumors 52(26.26%) and nerve sheath tumors 13(6.56%). STTs were most common in the third decade of life, with the head and neck region being the commonest site. All four malignant tumors were categorized using the FNCLCC grading system. There were three cases of Grade 2 sarcoma and one case of Grade 3 sarcoma. Conclusion: The most common benign tumors were vascular tumors followed by adipocytic tumors and nerve sheath tumors. STTs were most common in the third decade of life. Benign tumors were more common than malignant tumors. In comparison to malignant tumors, benign tumors were found at a younger age group. STTs were found mainly in the head and neck region followed by upper and lower limbs. Despite the fact that molecular diagnostics is gaining popularity in the field of soft tissue tumors, histopathology still remains the gold standard.
Appendiceal carcinoids are the most frequent tumors arising from the appendix, comprising between 32 and 57% of all the appendiceal tumors. The gross appearance of the appendix showed perforation at the tip with 30 ml of peri-appendicular collection. On histopathological examination, carcinoid tumor on the tip of appendix was found with tumor cells arranged in tubules, acini and nests infiltrating the muscularis propria and sub serosa. Perineural and vascular invasion was not seen. Immunohistochemistry for Synaptophysin was positive with Ki-67 labelling index of 2%. We present a case of appendiceal neuroendocrine tumor with the chief complaint of acute appendicitis.
Background Nephrectomy is a common and standard surgical practice in urology. It has pivotal role in diagnosis, treatment and prognosis of disease. It is indicated in patients with irreversible kidney damage following chronic infection, trauma, obstruction and malformation as well as renal malignancy. The objective of this study was to analyze the histomorphological spectrum of various lesions in nephrectomy specimens with special emphasis on grading and staging of renal carcinoma. Methods This is a retrospective study done from January 2015 to December 2020 in the Department of Pathology, Dhulikhel Hospital - Kathmandu University Hospital (DH - KUH). Relevant clinical data of the patients were obtained from the histopathological records of the patient from the pathology department. Results A total of 70 cases were studied, out of which 60 were simple nephrectomy specimens, followed by 8 radical and 2 partial nephrectomy specimens. The age of patient ranged from 2 to 74 years. Highest percentage of nephrectomy was seen in 4th decade of life. Male population comprising 54.28% of nephrectomy. Non-neoplastic lesions constituted 53 cases and chronic pyelonephritis was the most common lesion. Out of 17 neoplastic lesions, 76.47% of cases were malignant. Clear cell renal cell carcinoma was the most common malignant tumour. Conclusions This study gives a fair insight into the incidence of neoplastic and non-neoplastic lesions of kidney requiring nephrectomy in this institution.
Endometriosis is principally a disease of women in active reproductive life. Although it is rare, foci of endometrial tissue may be seen in the bowel, the umbilicus, abdominal surgical scars and in the lungs. Inguinal endometriosis is challenging to the clinicians and pathologist and often diagnosed accidentally. We present a case of inguinal endometriosis mimicking neoplasm. A 40 year old woman presented with a swelling in the right inguinal region associated with cyclical pain. In view of presence of atypical cells in fine needle aspiration cytology, metastatic carcinoma was rendered as diagnosis. Histopathological examination revealed endometrial glands and stroma which was further confirmed by immunohistochemistry. Diagnosis of inguinal endometriosis is difficult and often challenging because of unusual site. The clinician must have high index of suspicion with any patient who has cyclical symptoms. A good history and physical examination can guide clinical diagnosis of endometriosis.
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