Neutrophil-Lymphocyte Ratio for Predicting Coronary Artery Lesions in Children With Kawasaki Disease

Background: Coronary artery lesions (CAL) are a specific feature of Kawasaki disease (KD), and develop during the second week of illness. This study was conducted to determine whether Neutrophil: Lymphocyte Ratio (NLR), assessed between the fourth and sixth day of fever onset in children with KD, can predict coronary artery lesion (CAL) development. Methods: In this review of hospital records, data of patients with KD admitted at our center between January, 2016 and January, 2020 was retrieved. The patients were divided into two groups based on the presence of CAL, and clinical characteristics of patients were compared between the two groups. Results: Out of the 79 patients enrolled, CAL was found in 40 (50.6%) patients and intravenous immunoglobulin (IVIg) resistance was seen in 13 (16.5%) patients. Multivariate logistic regression revealed NLR as an independent predictor of CAL [OR (95% CI) 2.0 (1.2-3.1); P<0.001], and erythrocyte sedimentation rate (ESR) [OR (95% CI) 1.03 (1.001-1.1) P=0.04], as an independent predictor of IVIg resistance. NLR ?2.08 was 82% sensitive and 80% specific in predicting CAL. ESR ?88 mm/h was 85% sensitive and 64% specific in predicting IVIg resistance. Conclusions: NLR is an independent predictor of CAL in KD. NLR ?2.08 done between the fourth and sixth day of fever onset may identify children with KD at risk of CAL.

TO FIND CORRELATION OF CORE STRENGTH AND THORACIC ROTATION WITH SPEED OF THROWING IN CRICKETERS

Cricket is one of the most popular games which is played all over the world and its popularity has ever been increasing in the last decade. Fielding is an important dimension of the game as is batting and bowling. With the game being so fast with the introduction of 20 overs game fielding has had an increased demand in the sport. Throwing is considered one of the major and main activities of fielding. Throwing motions involve moving objects spatially using body segments, in particular, hand and arm segments, which can be classified into overarm throws, sidearm throws and underarm throws and divided into throwing objects quickly, accurately and far away. Aim of this study was to find The Correlation of Core Strength and Thoracic Rotation with Speed of Throwing in Cricketers. 31 Cricketers were assessed for their core strength with side rotational medicine ball throws and distance measured, Thoracic rotation in lumbar locked sitting position and measuring with universal goniometer and speed of throws with a BUSHNELL Speed gun. Results of this study showed that Core Strength and Speed of Throws showed a positive, strong and significant correlation whereas Thoracic Rotation and Speed of Throws also showed a positive and significant correlation. Core Strength showed greater clinical and statistical correlation with Speed of Throws than Thoracic Rotation. This study will not only help in preventing throwing injuries but also will help to train and enhance throwing abilities and overall performance

A Rare Cause of Breathlessness in a Patient on Hemodialysis

Background: The possibility of recurrence in COVID-19 is very rare and hence mostly underdiagnosed. In the face of pandemic, this can lead to circulation of the virus like a hidden iceberg. Better understanding about this topic can improve our knowledge of the COVID-19 pathogenesis and ways to control the transmission. Case presentation: A 41 year old male with no known comorbidities was admitted five times during a period of 7 months each time after being detected RTPCR positive for SARS-CoV-2 and more symptomatic than previously. He had no contact with other COVID-19 patients and was asymptomatic in between admissions. Despite this, he did not develop antibodies against SARS- CoV-2. Later on, he was diagnosed with thymoma on biopsy of the anterior mediastinal mass. Patient’s condition deteriorated on last hospitalization and he died, despite the treatment. Here we present an interesting report on multiple times recurrent COVID-19 infection, probably a case of reactivation and different plausible explanations on the role of thymoma. Conclusion: Acknowledging the potential of SARS-CoV-2 to cause recurrence is very important during the pandemic as a part of the long term transmission mitigation. The case report shows that previous infection does not guarantee complete immunity from COVID-19, especially in immuno-compromised patients. Hence, despite the status of prior infection, vulnerable individuals who recovered from COVID-19 should be under surveillance.

Attitudes toward Learning English and Procrastination in Students from a Private Institution Specialized in Foreign Languages in the City of Lima-Peru / Actitudes hacia el Aprendizaje de Inglés y Procrastinación en Estudiantes de una Institución Privada Especializada en Idiomas Extranjeros en la Ciudad de Lima-Perú

Abstract The current study has as its objective to analyze the relationship between students' attitude towards learning English and the procrastinating behavior at the academic level. Attitudes strengthen people's motivation to learn a foreign language (Delfín, 2007), and procrastination, which involves unjustified delaying of activities, causes negative consequences in completing academic tasks postponement of responsibilities (Rodríguez & Clariana, 2017). The design was correlational, and the sample consisted of 55 students learning English. The instruments were the Attitudes towards English language learning questionnaire and the academic procrastination questionnaire. According to the results, evidence shows that there is a positive median relationship between the variables, leading us to conclude that despite having positive attitudes towards learning English, procrastinating behavior does not diminish. The results of this study could be utilized in bilingual programs, or those could also be utilized to implement curricula in language programs at schools or universities. The idea is that higher education institutions include, as mandatory, the instruction of English as a global language.

Resumen El objetivo del trabajo fue analizar la relación que existe entre la actitud de los estudiantes hacia el aprendizaje del inglés y la conducta de procrastinar. Las actitudes refuerzan la motivación de las personas para aprender un idioma extranjero (Delfín, 2007) y la procrastinación, la cual tiene que ver con el aplazo injustificado de actividades, y provoca repercusiones negativas en las tareas académicas (Rodríguez & Clariana, 2017). El diseño fue correlacional y la muestra fue de 55 estudiantes de inglés. Los instrumentos fueron el cuestionario de Actitudes hacia el aprendizaje del idioma inglés y el cuestionario de procrastinación académica. De acuerdo a los resultados se evidencia que existe relación positiva media entre las variables, con lo cual se concluye que, a pesar de tener actitudes positivas hacia el aprendizaje del inglés, la conducta de procrastinar no disminuye. Los resultados de este estudio podrían ser utilizados en programas bilingües o podrían también ser utilizados para implementar currículos de programas de idiomas en escuelas y universidades. La idea es que las instituciones de educación superior tengan como obligación la implementación del curso de inglés como idioma global.

The influence of family history of cardiovascular disease on blood pressure, waist hip ratio and body mass index in adolescents

Background: Cardiovascular Diseases (CVDs) are the major cause of mortality in the world. Reducing the incidence of CVDs has been a challenge due to the multifactorial risk profile of their origin. Among the non-modifiable risk factor for CVDs family history holds a lot of importance. Objective of the study was to study blood pressure, waist hip ratio and body mass index among adolescents and verify the possible the relation with a family history of cardiovascular disease.Methods: This is a cross-sectional study, which was conducted in 286 school children aged 10 to 19 years, of either sex, from Barabanki. After getting consent from school authorities, children and their parents, a detailed history was taken with a pre-designed proforma. Anthropometric and blood pressure measurements were taken.Results: In the presence of any risk factor of CVDs, 33.9% of the adolescents were overweight/obese, 45.8% had abdominal obesity, 26.3% had elevated systolic BP and 35.6% had elevated diastolic BP. The group with family history of CVDs had significantly higher number of adolescents with obesity and/or hypertension.Conclusions: The present studied showed an important association between family history of CVDs and blood pressure, waist hip ratio and body mass index in adolescents.

The study of clinical and echocardiographic assessment of patients with atrial fibrillation

Background: Atrial Fibrillation is the most common arrhythmia encountered in our clinical practice accounting for 1/3rd of the total hospital admissions for cardiac rhythm disturbances. Recent worldwide epidemiological data have reaffirmed that AF is a global epidemic and has adverse effects on long term morbidity and mortality. This study is aimed to assess the clinical profile and etiology along with Echocardiographic evaluation of patients presenting with Atrial Fibrillation.Methods: Total of 100 patients of Atrial Fibrillation were enrolled for the study, who got admitted in hospital from March 2017 to June 2018. These patients were evaluated clinically, and detailed Cardiovascular, Neurological examination was done to evaluate etiology and for any evidence of thromboembolism. Echocardiography was also done.Results: Mean Age of the patients enrolled was 67.02±12.50 yrs. There was male predominance. The presenting complaints were dyspnea, palpitations, chest pain & pedal edema. On Echocardiography, Hypertensive Heart Disease was found to be the most common etiology. Mean LA size was 46.18±9.49 mm. LA clot was present in 4% patients. Most common complication was congestive cardiac failure followed by stroke. CHA2DS2- VASc score was ?2 in 86% patients.Conclusions: Increasing age and hypertension are associated with occurrence of AF. Hypertensive heart disease was the most common etiology in elderly age group. Presence of LVH or left atrial enlargement in patients with hypertensive heart disease requires early management to improve the outcomes.

Management Of 3rd Degree Hemorrhoids With Stapled Haemorrhoidectomy Vs. Open Haemorrhoidectomy A Prospective Randomized Study.

ABSTRACT:Introduction:Manysurgicalandnon‐surgicaltreatmentmodalitiesareavailableformanagementofhemorrhoidsofwhichHaemorrhoidectomyisregardedasthegoldstandardoftreatment.ConventionalopenHaemorrhoidectomyiswidelyperformed&hasstoodthetestoftime.StapledHaemorrhoidectomyisnewerprocedureinthemanagementofhaemorrhoids.Ourstudyaimstocomparethetwosurgicalmodalitiesinrelationtothetechnique&timedurationofsurgery,post‐operativestay&complications.Methods:AprospectiverandomizedstudywasconductedatAMCMETMMC&LGhospitalsAhmedabadbetween1stJanuary2016&1stSept2016.Allpatientspresentingwith3rddegreehaemorrhoidswererandomizedbetweenOpen&StapledHaemorrhoidectomygroups&comparedwithrelationtomeanoperativetiming,complicationspostoperativelynamelyhemorrhage,urinaryretention&post‐operativepain,durationofhospitalstay,durationforresumingnormalworkafterdischarge.Allcaseswerethoroughlystudiedandfollowedupforperiodof3months.Datawasassessedbymulti‐variationanalysisbypairedTtest&Wilcoxonanalysis.

Operative management of chondrosarcoma in pelvic region: case series

Chondrosarcoma is the second most frequent malignant bone tumour after osteosarcoma. It most often occurs in the pelvis. Treatment of pelvic chondrosarcoma is a difficult problem for the musculoskeletal oncologist. We report 3 patient with chondrosarcoma in pelvic region that undergoing internal hemipelvectomy. First patient, male 28 y.o. with chondrosarcoma in left iliac wing 11.2cm x 10.8cm x 9.2cm. Second, woman, 47 y.o with chondrosarcoma in right superior and inferior pubic rami 13.7cm x 11.5cm x 14.2cm with soft tissue mass around extended to medial part of proximal thigh. Already done A wide excision of the tumor was performed and we use non-vascularized fibular graft (NVFG) to fill the defect. Last patient, pregnant woman 22 y.o. (16weeks gestational age) with chondrosarcoma in right pubic rami 9.8cm x 11.4cm x 13cm. We already done internal hemipelvectomy without terminating the fetus. The second and third patient confirmed with the histopathology result with chondrosarcoma grade II, and the first patient with chondrosarcoma grade I. After 3month post operatively, all of the patients have no pain, no urinary tract complain. The first patient can ambulatory full weight bearing with no crutches or walker. Second patient ambulatory partial weight bearing with crutches. The last patient ambulatory with wheel chair during the pregnancy. Since chondrosarcomas are unresponsive to chemotherapy or radiotherapy, surgical resection was the only therapeutic solution for these patients. It also reinforce the need of a correct diagnose and collaboration between specialities in the treatment of oncological patients.

Intra-Operative Assessment Of Laparoscopic Cholecystectomy

Gallbladder-related disease is now one of the commonest indications for elective and emergency surgery. Management of cholecystitis and its complications has evolved dramatically.1There have been significant paradigm shifts in the management of patients since the introduction of laparoscopic cholecystectomy in the mid1990s.2Laparoscopic cholecystectomy is the current gold standard for the treatment of symptomatic cholelithiasis.3But the severity of cholecystitis may be different in every patient and performing laparoscopic cholecystectomy may be difficult accordingly. Conversion from laparoscopic to open cholecystectomy is the essential part of the safe surgical practice if the anatomy is unclear, if complications arise, or if there is failure to make reasonable progress in a timely manner.4 Recently the importance of index admission laparoscopic cholecystectomy has been highlighted.5 In many large series and meta analyses detailed patient demographics and imaging findings have been recorded. A number of international guidelines recommend pathways of care.Attempts have been made to standardize definitions particularly relating to cholecystitis6,7.Despite these advances, significant variability in approaches to care and outcomes in gall-bladder disease management are reported.8While a number of preoperative scoring systems are reported there is no operative classification of findings at laparoscopic surgery.9,10.This limits the ability to compare outcomes or provide a common benchmark for future research. This prospective study was aimed to assess and grade the degree of difficulty in laparoscopic cholecystectomy and their postoperative outcome using intraoperative scoring system devised by Sugrue M et al.

Clinical profile of opportunistic infections in HIV seropositive patients attending tertiary centre, Raichur, India

Background: According to Karnataka state HIV statistics, HIV positivity among general clients tested at ICTCs, Raichur (4.9%) had third highest proportion of HIV positive cases. Authors decided to focus on opportunistic infections (OIs) in HIV patients of Raichur district since they contribute to the mortality and morbidity.Methods: It’s a cross sectional, hospital-based study with 100 patients with HIV infections as per NACO guidelines with features of OIs were included in study.Results: In this study, 77 males (77%), 23 female (23%) patients with 58% (n=58) of them in 30-39yrs age group and 21% (n=21) in 20-29yrs were seen. Majority of cases were laborers (47%) and less educated (n=55). Symptoms included loss of appetite (76%) n=76, fever (72%) n=72, cough (55%) n=55 and diarrhoea15% (n=15). The respiratory system was most frequently involved by opportunistic infections and accounted for 56% (n=56) of the total cases and clinically consolidation/crepitation was most frequent presentation accounting for 75% (n=42). Tuberculosis was most common OI (55%) with combined pulmonary and extra pulmonary in 56.37% (n=31), tubercular meningitis and tubercular lymphadenopathy each accounting for 30.77% (n=12) amounted majority, with pleural effusion 20.52% (n=8). Median CD4+T cell count was 217.72 in TB. Candidiasis is second most common OI with 49% (n=49), median CD4 count being 190.07. Other OIs observed were pneumocystosis 16% (n=16), cryptococcosis 2% (n=2).Conclusions: Most common OI in the study was tuberculosis (in extra pulmonary TB meningitis and TB lymphadenitis) followed by Candidiasis, Pneumocystosis and Cryptococcosis.

A Clinical Study On Effect Of Gokshura Kwatha In The Management Of Mutraghata W. S. R. To B.p.h

Introduction: 慚utraghata� can be equated with group of obstructive uropathic disorders. As explained in Sushrutha Samhitha, it is of 12 types and 慥atasthila� is one among them, which is closely similar to Benign Prostatic Hyperplasia. BPH is a progressive disease of advancing age. Histologically the inner zone of the periurethral gland undergoes hypertrophy and an adenoma is formed. Usually men around 60 years, suffer from mild, moderate and severe grade of BPH. Objectives: To evaluate the efficacy of Gokshura kwatha in the management of Mutragatha/ B.P.H. and to improve quality of life of BPH sufferer. Method: It is a single blind, clinical study on diagnosed cases of B.P.H, Gokshura kwatha was given for 60 days (20ml BD) with Sita and honey with follow-up of 4 months. Changes in subjective criteria (by IPSS Index) and objective criteria (by USG) were recorded before and after treatment. Result: Gokshurakwatha shown more significant relief on associated symptoms of Mutraghata including, burning sensation, painful micturition, pus and blood discharge etc. Interpretation: On the basis of the beneficial effects of Gokshura kwatha churna, it can be opined that it gives good result symptomatically. Conclusion: The subjective features were relieved significantly. But observed, no much difference in the objective criteria. The effect of Gokshurakwatha on the straining significantly reduced, prostate size has not reduced significantly. As for follow up period, relief of symptoms observed to be sustained up to one month in majority of patients.

A Beginner Surgeon’s Experience Of Minimal Access Surgery At Tertiary Care Hospital

Introduction: Minimal access surgery is the need of the hour for departments of surgery running throughout the country. Laparoscopic surgeries are being performed routinely in surgical departments with increasing frequency. Basic laparoscopy surgeries are nowadays incorporated in training programs for post graduate students. Therefore it is important for a surgeon to achieve enough experience in basic laparoscopy and move on to advanced laparoscopic procedure for benefit of the continuing field of surgical educationMaterial & Methods: in this prospective observational study, 120 cases of laparoscopic surgery performed at department of general surgery, AMC MET MMC were reviewed in terms of age & sex distribution, mean operative time & post op complications.

Is Political Activism on Social Media an initiator of Psychological Stress?

Objective: To find out the association of psychological stress with political activism on social networking sites [SNS] in adults. To find association of psychological stress and political activism with age, gender and occupational status

Methods: A descriptive cross-sectional study of 8 months [Aug 2014 to March 2015] was conducted on young adults between age group of 20-40 years of different universities of Rawalpindi, Pakistan. Closed ended standardized questionnaires [i.e. Cohen Perceived Stress-10] were distributed via non-probability convenient sampling among a total sample size of 237. Sample size was calculated using WHO sample size calculator and data was analyzed in STATA version 12

Results: The mean age of participants was 21.06 + 1.425 years. Out of the 237 participants, 150 [63.3%] were males and 87 [36.7%] females. Regarding their occupation, 13 [51.9%] were military cadets, 8 [3.4%] were consultant, 47 [19.8%] medical officer, 3 [1.3%] PG students and 56 [23.6%] MBBS students. Significant association of occupation was established with both political activism and psychological stress [p=0.4 and p=0.002 respectively]. Among 237 individuals, 91 [38.4%] were stressed out and 146 [61.6%] were not. Among whole sample, political activists on SNS were found to be 23 [9.7%]. Out of these 23 individuals who were politically active, 15 [65.2%] were stressed out and 8 [34.7%] were not. A significant association between stress and political activism was established [p=0.005]

Conclusion: Political activism via social networking sites is playing significant role on adult person's mental health in terms of stress among different occupation

A Study Of Ocular Disorders In School Going Children.

Background: Ocular disorders are often neglected in children. At the school going age. They find difficulties in their day to day activities. Refractive Error affects a large proportion of school going children. This can be easily diagnosed and corrected with spectacles. If not corrected, they become a major cause of low vision or even blindness. In India, children younger than 15 years constitute about 42% of the population and out of it 30% lose their eyesight partially due to amblyopia before the age of 20 years. So we have selected this study. Methodology: This was a cross sectional study. The study was conducted in Dhiraj Hospital & Eye camps for school children during November 2014 to October 2015. We have examined 350 children. We have used snellen’s distant vision chart, torch light, direct ophthalmoscope and ishihara’s colour vision chart in the camps. We referred children who needed detailed examination to Dhiraj hospital where we did cycloplegic refraction. They were examined with auto refractometer , direct and indirect ophthalmoscopy and they were called for Post mydriatic test and also for follow up of other ocular disorders. Results: Our study was conducted in schools of Vadodra district and in Eye Opd of Dhiraj Genral hospital attached with SBKS MIRC pipariya , dist. Vadodara in Gujarat state. We have examined 350 children and done their complete follow up. We found refractive error in 130 (37.14%) in children. Amongst them Refractive error -130 and other disorders like Lacrimal sac disorder – 6, Meibomian gland dysfunction (MGD) – 9, Conjunctivitis- 12 , amblyopia -3 ,squint -1, Others (Normal)- 189. P value was significant in case of refractive error. Conclusion: Ocular disorders in school going children vary from place to place, mal nutrition, lack of attendance from parents & teachers on their complains of eye disorders, in some areas where treatment facility in private or government set up is not available so their problems are neglected. Climate condition also play significant role. The present study indicates that the school age is a high risk group for developing refractive errors. Most of the children were unaware of their problem. Thus prevalence of undetected refractive error was more. Allergic conjunctivitis was another issue of concern. More studies, resources and manpower are needed to detect uncorrected refractive error and achieve the goal of vision 2020.

Early Infant Feeding Practices May Influence the Onset of Symptomatic Celiac Disease / 대한소아소화기영양학회지

PURPOSE: To study whether breastfeeding and breastfeeding status during gluten introduction influences the age at diagnosis of celiac disease (CD). In addition to study, whether the timing of gluten introduction influences the age at diagnosis of CD. METHODS: It was a hospital based observational study. Total 198 patients diagnosed with CD as per modified European Society of Pediatric Gastroenterology, Hepatology and Nutrition (2012) criteria, aged between 6 months to 6 years were included. Detail history taken with special emphasis on breastfeeding and age of gluten introduction. Standard statistical methods used to analyze the data. RESULTS: Mean±standard deviation age of onset and diagnosis of CD in breastfed cases was 2.81±1.42 years and 3.68 ±1.55 years respectively as compared to 1.84±1.36 years and 2.70±1.65 years respectively in not breastfed cases (p<0.05). Those who had continued breastfeeding during gluten introduction and of longer duration had significantly delayed onset of disease. The age at onset of CD was under one year in 40.42% of the cases, who had started gluten before 6 months of age compared to only 12.58% of those who had started gluten later (p<0.001). The proposed statistical model showed that two variables, i.e., breast feeding status during gluten introduction and age at gluten introduction positively influencing the age at diagnosis of CD. CONCLUSION: Delayed gluten introduction to infant's diet along with continuing breastfeeding, delays symptomatic CD. However, it is not clear from our study that these infant feeding practices provide permanent protection against the disease or merely delays the symptoms.

Outcome of Heliotherapy and Modified Parkland’s Formula for Fluid Resuscitation in Management of Moderate Degree of Burns: A Single Centre Observational Study.

Background: Acute resuscitation is one of the most challenging aspects of caring for burned patients. Although the Parkland formula is still the most common employed resuscitation formula worldwide, it is far from a perfect solution. Materials and Methods: This is a prospective observational study, which was carried out over a period of 3 years. A total of 50 patients were enrolled. Modified Parkland formula and heliotherapy were used in the management of moderate degree burns. Result: Out of 50 patients with Moderate degree of burns 47 survived (mortality rate: 6%). One of the deaths in occurred during the period of resuscitation (day 2). While the other two deaths were related to septic shock. Urine Output (ml/kg/h) of 0.72 ± 0.06 and 0.92 ± 0.05 was noted on day 1 and 2, respectively. Conclusion: Modified Parkland formula and heliotherapy proved to be effective in our set-up in comparison to the conventional Parkland formula and protocol for management of burns, as reflected in the published literature, thus, we recommend multicentric trials to test the efficacy of this technique, in management of burns.

A Review on Biomaterial Design for Vascular Tissue Engineering Applications.

Biomaterials play a critical role in the success of tissue engineering approaches as they guide theshape and structure of developing tissues, provide mechanical stability, and present opportunities to deliver inductive molecules to transplanted or migrating cells. Therefore, the selection of theappropriate biomaterial can have a profound impact on the quality of newly formed tissue. A major challenge facing the field of tissue engineering is the development or identification of materialscapable of promoting the desired cellular and tissue behaviour. Given that few biomaterials possess all the necessary characteristics to perform ideally, engineers and clinicians alike have pursued thedevelopment of hybrid or composite biomaterials to synergize the beneficial properties of multiplematerials into a superior matrix.The combination of natural and synthetic polymers with variousother materials has demonstrated the ability to enhance various properties required for tissue engineering. In this review, we have made an attempt to review artificial components such as polymers, and strategies to design a composite which offer the desired physical properties. We also discuss synthesis methods for designer biomaterialsand its applications in vascular tissue engineering. The continued development andimplementation of hybrid biomaterials will lead to further successes in tissue engineering andregenerative medicine.The articles written with this goal in mind are by no meansexhaustive and are only intended to stimulate the community tothink more broadly about biomaterial composites and their designing.