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The two Houses of Parliament, its committees, and their members are granted specific rights, immunities, and exemptions known as "parliamentary privileges." The Indian Constitution's Article 105 defines certain rights. Members of Parliament are protected by these privileges from civil liability for statements made or actions taken while performing their official duties, but not from criminal culpability. Only when a person is a member of the house can they make use of the privileges. The privileges are stated to be terminated as soon as the person ceases to be a member. The privilege matters only see the question of Parliament and Court relationship. It involves certain facets, that are who amongst the Court or the Legislature, decides whether a particular privilege claimed by a House exists or not? When a privilege is held to exist, is the House the final judge of how, in practice, that privilege is to be exercised? Can the Courts go into the privilege of validity or proprietary of committal by a House for its contempt or breach of privilege? Can the Courts interfere with the working of the Committee of Privileges? These are the areas that shall be dealt with in the following article to clarify the relation existing between the privileges provided to parliamentarians and the powers of the Courts.
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Background : Presence of thalassaemia is considered high risk in pregnancy. The present study find out the role of antenatal and intrapartum care to improve the outcome of pregnancy in thalassaemia. Materials and Method : The prospective longitudinal study was carried out on 25 patients. CBC, LFT, Ferritin, Hb electrophoresis, serial USG was done. Chorionic villous sampling was offered to thalassaemic women to decrease the number of babies born with Thalassaemia. Furthermore, management and treatment options provided to mother to overcome the incidence of maternal and neonatal complications during current pregnancy. Results : 44% of thalassaemic pregnant women had HbE ? thalassaemia, 8% ? thalassaemia major and others had thalassaemia carriers, while only 20% of their partners showed ? thalassaemia trait. All patients were anemic and during delivery mean Hb% were 8.42 g/dl, MCH 22.09 pg, MCV 73.56 fl, MCHC 29.86 g/dl and ferritin 241.51 ng/ ml. Third trimester USG exhibited 32% developed IUGR (Intrauterine growth restriction). 40% patients received blood transfusion after delivery. ? thalassaemia trait was identified in 20% babies at 6 month. Conclusion : Postpartum haemorrhage is a major complication of thalassaemia in pregnancy. After delivery a thorough neonatal check-up and haematological work-up is important for prevention of neonatal mortality and early detection of thalassaemia.
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Background: The COVID-19 has taken the world by storm. It primarily affects the lungs causing respiratory distress and leading to ARDS. Aim: The aim of this study is to evaluate the coagulation dysfunction in patients which predisposes the patients to venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilisation and diffuse intravascular coagulation (DIC). Material & Methods: We assessed 2281 COVID RT PCR positive patients who were admitted with moderate to severe disease in wards and ICU respectively. The coagulation profile was done for each of these patients and the tests included Prothrombin time (PT), Activated Partial Thromboplastin Time (APTT) and D-Dimer. The PT and APTT were estimated on ACL elite pro (Fully automated coagulation analyser) which is based on nephelometry. D- Dimer was measured using ACL elite pro and latex agglutination (semi quantitative method). Results: Out of 2281 COVID RT PCR positive patients 1655 (72.5%) were males and 626 (27.5%) were females. It was observed that percentage of patients admitted in ICU had increased D dimer values and it was statistically significant. Our study showed that larger number of patients admitted in ICU had PT value more than 12.5 seconds and APTT more than 35.5 seconds, however it was not statistically significant. Our study also demonstrated that patients having higher D dimer required longer hospitalization with significant p value. Conclusion: We concluded that assessment of coagulation profile is necessary for patients infected with this virus so as to prevent any thrombotic complications and therefore preventing morbidity and mortality.
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The American Academy of Neurology (AAN) has recently updated its practise advisory on antiseizure medication withdrawal. The recommendations have been formulated for pediatric as well as adult epilepsy, with emphasis on the risk factors for seizure relapse, occurrence of status epilepticus or death on drug withdrawal, and effect on quality of life in both age groups. We herein list the important aspects of the updated recommendations in pediatric epilepsy for the benefit of the general pediatricians. The full update is available at the AAN website.
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Background & objectives: Activation of renin-angiotensin system and tubulointerstitial damage might be seen in pre-albuminuria stage of diabetic nephropathy (DN). Here, diagnostic utility of four urinary biomarkers [Angiotensinogen (Angio), Interleukin (IL)-18, Neutrophil Gelatinase-Associated Lipocalin (NGAL) and Cystatin] during pre-albuminuria stages of non-hypertensive type 2 diabetes patients was studied. Methods: A total of 952 type 2 diabetes mellitus (T2DM) patients were screened for nephropathy [estimated glomerular filtration rate (eGFR) ?120 ml/min and albumin–creatinine ratio (ACR) ?30], and 120 patients were followed up for one year. At one year, they were classified into hyperfiltration (43), normoalbuminuria (29) and microalbuminuria (48) groups. Another 63 T2DM patients without nephropathy were included as controls. Hypertension, patients on angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, eGFR <60 ml/min/1.73 m2 and all proteinuric conditions were excluded. All were subjected to testing for urine protein, ACR, HbA1C, eGFR, along with urinary biomarkers (IL-18, cystatin-C, NGAL and AGT). Comparative analysis of all the diagnostic tests among different subgroups, correlation and logistic regression was done. Results: Urinary IL-18/Cr, cystatin/creatinine (Cr) and AGT/Cr levels were higher in groups of hyperfiltration (13.47, 12.11 and 8.43 mg/g), normoalbuminuria (9.24, 11.74 and 9.15 mg/g) and microalbuminuria (11.59, 14.48 and 10.24 mg/g) than controls (7.38, 8.39 and 1.26 mg/g), but NGAL/Cr was comparable. The area under receiver operating characteristic curve (AUC) and sensitivity of AGT to detect early CKD were higher than ACR and eGFR (0.91 and 90.4%, 0.6 and 40% and 0.6 and 37%, respectively). AUC values of other biomarkers, namely IL-18/Cr, cystatin/Cr and NGAL/Cr, were 0.65, 0.64 and 0.51, respectively. Angio/Cr and IL-18/ Cr showed correlation with log albuminuria (r=0.3, P=0.00, and r=0.28, P=0.00, respectively). NGAL showed correlation with log eGFR (r=0.28 P=0.00). Multivariate logistic analysis showed that odds ratio of developing nephropathy was 7.5 times with higher values of log Angio/Cr. Interpretation & conclusions: Urinary AGT showed a higher diagnostic value than ACR and eGFR followed by IL-18 and cystatin to diagnose DN during pre-albuminuric stages.
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Justification: Global developmental delay (GDD) is a relatively common neurodevelopmental disorder; however, paucity of published literature and absence of uniform guidelines increases the complexity of clinical management of this condition. Hence, there is a need of practical guidelines for the pediatrician on the diagnosis and management of GDD, summarizing the available evidence, and filling in the gaps in existing knowledge and practices. Process: Seven subcommittees of subject experts comprising of writing and expert group from among members of Indian Academy of Pediatrics (IAP) and its chapters of Neurology, Neurodevelopment Pediatrics and Growth Development and Behavioral Pediatrics were constituted, who reviewed literature, developed key questions and prepared the first draft on guidelines after multiple rounds of discussion. The guidelines were then discussed by the whole group in an online meeting. The points of contention were discussed and a general consensus was arrived at, after which final guidelines were drafted by the writing group and approved by all contributors. The guidelines were then approved by the Executive Board of IAP. Guidelines: GDD is defined as significant delay (at least 2 standard deviations below the mean with standardized developmental tests) in at least two developmental domains in children under 5 years of age; however, children whose delay can be explained primarily by motor issues or severe uncorrected visual/ hearing impairment are excluded. Severity of GDD can be classified as mild, moderate, severe and profound on adaptive functioning. For all children, in addition to routine surveillance, developmental screening using standardized tools should be done at 9-12 months,18-24 months, and at school entry; whereas, for high risk infants, it should be done 6-monthly till 24 months and yearly till 5 years of age; in addition to once at school entry. All children, especially those diagnosed with GDD, should be screened for ASD at 18-24 months, and if screen negative, again at 3 years of age. It is recommended that investigations should always follow a careful history and examination to plan targeted testing and, vision and hearing screening should be done in all cases prior to standardized tests of development. Neuroimaging, preferably magnetic resonance imaging of the brain, should be obtained when specific clinical indicators are present. Biochemical and metabolic investigations should be targeted towards identifying treatable conditions and genetic tests are recommended in presence of clinical suspicion of a genetic syndrome and/or in the absence of a clear etiology. Multidisciplinary intervention should be initiated soon after the delay is recognized even before a formal diagnosis is made, and early intervention for high risk infants should start in the nursery with developmentally supportive care. Detailed structured counselling of family regarding the diagnosis, etiology, comorbidities, investigations, management, prognosis and follow-up is recommended. Regular targeted follow-up should be done, preferably in consultation with a team of experts led by a developmental pediatrician/ pediatric neurologist.
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Purpose: To study corneal endothelial changes post phacoemulsification in diabetic and non?diabetic patients. Methods: A comparative, prospective, observational study was conducted on 100 diabetic and 100 non?diabetics who underwent phacoemulsification. All patients were operated by the same surgeon by using the phaco chop technique to exclude any surgeon?related bias. Endothelial cell count, CCT, and coefficient of variance (CV) were measured with a specular microscope along with BCVA preoperatively and at 1 week, 4 weeks, and 3 months postoperatively. For statistical analysis, data were analyzed by using SPSS (version 27.0; SPSS Inc., Chicago, IL, USA). Data were summarized as mean and standard deviation for numerical variables and count and percentages for categorical variables. Chi square test, independent sample T test, and paired T test were used to compare the data. P ? 0.05 was considered statistically significant. Results: Postoperatively at 1 week, 4?week, and 3 months follow?up intervals, the mean endothelial cell count and coefficient of variance were significantly higher, and the mean percentage of hexagonal cells was significantly lower in non diabetic as compared to the diabetic group. A significant difference in mean central corneal thickness of the two groups was observed at 1?week and 4?weeks postoperative intervals; at both these intervals, the mean value was significantly higher in non diabetic as compared to the non?diabetic group. However, at 3?months post?operative interval, the difference between the two groups was not significant statistically. Mean BCVA values were significantly higher in diabetic as compared to the diabetic group at all three follow?up intervals. Conclusion: The findings of the present study show that endothelial cell characteristics are adversely affected in diabetic eyes as compared to non?diabetic patients undergoing phacoemulsification; this might also have an effect on the visual outcomes.
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Lumpy skin disease (LSD) is one of the most economically valuable transboundary and OIE-listed diseases caused by Capripoxvirus in the family Poxviridae. LSD should always be included in the differential diagnosis when cattle exhibit tiny nodules development in the head, neck, udder, rump, perineum, and leg area and elevated body temperature, respiration, and salivation. The economic potential of these diseases is of significant concern, provided that they threaten international trade and could be used as economic bioterrorism agents. Because of the scarcity of reliable vaccinations and the widespread poverty in rural areas, capripoxviruses appear to be spreading more widely. The best treatment for reducing the risk factors for the disease could be strict quarantine, vector control, and prophylactic vaccination. The goal of the current study is to give the information that is currently available on the disease’s various aspects, including its clinicopathology, method of transmission, possible treatments, and diagnostic procedures
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Background: The term substance is usually used to address psychoactive/psychotropic drugs which include both licit and illicit drugs. These substances have varied consequences, including long?term and short?term effects, which include sensations post?consumption. Aim: To determine patterns of substance use and short?term oral health effects among substance users. Materials and Methods: A self?administered questionnaire?based study was conducted on the inmates of drug deaddiction and rehabilitation centres in Bhubaneswar city. Results: All the subjects were males and majority (60.6%) were polydrug users. Alcohol (87.3%) was the most commonly used substance, followed by ganja (57%), bhang (35.3%) and brown sugar (33%). A wide range of oral health sensations like dryness of mouth, taste change, numbness in mouth, feeling like chewing something, loose teeth and stammering/difficulty in speaking were found to be significantly associated with substance use. The age of start of substance use (P < 0.0001), socioeconomic status (P = 0.026) and marital status (P < 0.0001) were significantly associated with the pattern of substance use. About 37.6% of inmates felt that they had very good oral health before starting drug use, while only 15.4% described their oral health as very good at present. Having no oral health problem was the most common reason for not visiting a dentist, followed by ignorant attitude towards oral health. Conclusion: A wide range of oral health sensations were found to be caused due to substance use. Understanding of oral health sensations can aid practitioners detect and report cases of substance use in its early phase.
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Non-immunoglobulin intracytoplasmic inclusions in plasma cells of multiple myeloma are very rare presentation. These are morphologically similar to Auer rods but chemically different from them. We studied two cases of multiple myeloma in a 60-year-old woman and 45-year-old man. In both cases, plasma cells of bone marrow aspirate revealed multiple Auer rod-like inclusions (ARLI). Sudan black B (SBB) and myeloperoxidase (MPO) cytochemistry were negative. Serum protein electrophoresis in both of them showed M spike, one with raised IgA-kappa levels, while the other with raised IgG-kappa levels. Very few case reports have been published in the literature and its prognostic implications are still unknown. Due to its rarity, it is important to distinguish such cases from acute myeloid leukemia and its exact incidence with its therapeutic and prognostic implications
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Rationale: Genitourinary tuberculosis can develop during the disease course of disseminated disease and the distinctive histological finding is epithelioid granuloma with or without caseation and accompanied Langhans-type giant cells. Barely, the lesion is only restricted to kidney involving both glomerular and extraglomerular compartment. Association with immune complex-mediated glomerulonephritis has been sparsely reported in the literature. Patient concern: A 42-year-old non-diabetic, non-hypertensive male presented with generalized body swelling and frothing of urine for 3 months. Diagnosis: Membranous nephropathy with tuberculous interstitial nephritis. Intervention: Anti-tuberculous therapy for extrapulmonary tuberculosis was administered along with low dose corticosteroid. Outcomes: Reduction of proteinuria was achieved at one month follow-up visit. Lessons: Tuberculosis should be considered as a potentially treatable cause of secondary membranous nephropathy as pharmacotherapy greatly helps improve the outcome.
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Rationale: Genitourinary tuberculosis can develop during the disease course of disseminated disease and the distinctive histological finding is epithelioid granuloma with or without caseation and accompanied Langhans-type giant cells. Barely, the lesion is only restricted to kidney involving both glomerular and extraglomerular compartment. Association with immune complex-mediated glomerulonephritis has been sparsely reported in the literature. Patient concern: A 42-year-old non-diabetic, non-hypertensive male presented with generalized body swelling and frothing of urine for 3 months. Diagnosis: Membranous nephropathy with tuberculous interstitial nephritis. Intervention: Anti-tuberculous therapy for extrapulmonary tuberculosis was administered along with low dose corticosteroid. Outcomes: Reduction of proteinuria was achieved at one month follow-up visit. Lessons: Tuberculosis should be considered as a potentially treatable cause of secondary membranous nephropathy as pharmacotherapy greatly helps improve the outcome.
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The study aimed to evaluate ultrasonographic findings, radiography, and blood profile in 24 bitches presented for treatment of pyometra. Clinical symptoms such as anorexia, vaginal discharge, depression, polyuria/polydipsia, vomiting, and abdominal distension were seen. Among these various types of diagnostic approaches, ultrasonography a powerful tool for the early detection of uterine abnormalities. Before any clinical alterations could be noticed, ultrasonography allowed the diagnosis of pathologic abnormalities. Pyometra must be identified, diagnosed, and treated as soon as possible to achieve a successful outcome
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The breeding soundness examination (BSE) predicts about bull’s potential to get cows pregnant. To identify a bull’s potential fertility, breeding-soundness examinations are frequently used in the beef industry. Bull BSE is a simple, cheap, and essential tool for a cow-calf operation. BSE enhances risk management, strategic bull use, herd fertility, and economics. It is carried out to determine a bull’s libido, and reproductive status, and to test for different genital diseases. Based on the BSE bulls are given one of three classifications: “satisfactory,” “unsatisfactory,” or “classification postponed”. Accurate Semen evaluation is an important factor of the BSE. Competent physical/reproductive exams and appropriate semen evaluations can contribute greatly to the fertility and economics of individual herds as well as understanding of factors which affect fertility
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Background: Malaria is a disease with a great global burden. It is one of the most prevalent parasitic infection common intropical, subtropical countries, particularly Asia and Africa. Malaria causing plasmodia is parasites of blood and hence induceshematological alterations. The hematological changes that have been reported to accompany malaria include anemia,thrombocytopenia, leukocytosis as well as leukopenia, mild-to-moderate atypical lymphocytosis, monocytosis, eosinophilia,and neutrophilia. Hence, the present study is undertaken to evaluate the various hematological parameters affected in malariaand to observe the variations, if any, in Plasmodium falciparum, Plasmodium vivax, and mixed infections.Materials and Methods: The present study was carried out in the Department of Pathology at Tertiary Health Care Centerof South Gujarat from August 2018 to October 2018. A total of 480 smear-positive malaria cases were analyzed and varioushematological parameters were studied.Results: Out of 480 smear-positive cases, P. vivax was positive in 77% of cases, P. falciparum was positive in 22% of casesand mixed infection in 1% of cases. Most of the cases were seen in the age group of 21–40 years. Anemia was seen in 53.1%of cases. Normocytic normochromic blood picture was the most common type in anemic patients (46.6%). Thrombocytopeniawas seen in 84.58% of the patients. Out of which, 75.86% were affected by P. vivax, 23.15% were affected by P. falciparum,and 0.98% were affected by the mixed infection. About 28.75% of cases showed hematological features of leukopenia, and5.2% of cases were having leukocytosis.Conclusions: Various hematological findings can help in early diagnosis of malaria which is essential for timely and appropriatetreatment which can limit the morbidity and prevent further complications
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Introduction: Ovarian cancer is the third most common cancer among women of India. Microscopic examination is the goldstandard for diagnosing ovarian tumors and plays an important role in determining prognosis.Purpose: The aim of the study is to assess the frequency of non-neoplastic and neoplastic lesions in ovarian specimens andbiopsies and to study the histomorphological spectrum, gross features, and age distribution of the ovarian tumors.Materials and Methods: The present study was an observational retrospective study conducted over a period of 1 year(February 2019–January 2020) in the Department of Pathology in a Tertiary Care Hospital in South Gujarat. A total of cases (8ovarian biopsies and 82 ovarian specimens) were analyzed. Tumors were classified according to the WHO classification 2014.Results: Of 90 cases, eight were of non-neoplastic lesions, 13 were tumor-like lesions, and nine neoplastic lesions. Amongneoplastic lesions, 43 cases (62.3%) were benign, 3 (4.4%) were borderline, while 23 (33.3%) cases were malignant.Histopathologically, surface epithelial tumors (76.7%) were the most common subtype followed by germ cell tumors (13.3%)and then sex cord tumors (10%). Malignant surface epithelial tumors constitute 78.2% of the total malignant ovarian tumors. Themost common neoplastic lesion was serous cystadenoma. 30–39 years age group was the most common age group overall inovarian tumors. Benign tumors were most common in the 30–39 years age group, while malignant tumors were most commonin the 60–69 years age group. Bilaterality was seen in 10 (16.4%) of 61 gross specimens of ovarian tumors.Conclusion: The frequency of malignant ovarian tumors was higher in our institute. Accurate histopathological diagnosis isessential for management and determining prognosis
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Background: Information on the profile of infants with West syndrome in developing countries is limited. This study was done to determine clinico-etiological profile and clinical response of infantile spasms to various medications in children with west syndrome in a developing country.Methods: It was a retrospective cohort study from January 2017-january 2020 done in a tertiary care hospital in western India. Records of 39 children with west syndrome who visited this pediatric neurology division during study period were analysed. 6 were excluded in view of incomplete data. Detailed history, examination, investigations and medications given were noted. Follow up records were assessed to look for long term control of spasms, relapse rates after cessation, or progression to other seizure types.Results: Mean age at onset of infantile spasms was found to be 8.12 months (1 - 36 months).' Mean lag time to treatment was 5.35 months. Etiology was found in 69.7% children with perinatal causes being most common. With oral prednisolone, 54.5% had complete cessation of spasms, and with ACTH also 54.5% had complete spasm cessation. Favourable clinical response at 6 months follow up was found in 8 (47.05%) of the 17 children. Surprisingly, lag time (p=0.381) and symptomatic etiology (p=1.00) did not have any significant impact on outcome.Conclusions: This study highlights the developing country perspective of west syndrome. Increased lag time, different etiological profile and poor outcome are the challenges. High dose prednisolone is a good first line alternative treatment option in resource poor settings.
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Background: Asthma in children is difficult to diagnose due to inability of young children to successfully perform spirometry. However some parameters in the spirometry which are relatively effort independent can be very helpful in confirming the diagnosis of asthma. This study was conducted to find out the most commonly affected spirometry parameter in the suspected cases of childhood asthma.Methods: Total 56 children were studied between 7 to 18 years who came for outpatient visit or admitted in the paediatric ward and were clinically suspected to be asthmatic based on asthma predictive index. They were subjected to spirometry in our institute. Baseline and post bronchodilator values of spirometry parameters were studied and analysed using standard statistical tests.Results: Baseline Forced expiratory flow between 25% and 75% of vital capacity (FEF25-75%) was found to be the most commonly affected spirometry parameter in confirming the diagnosis of suspected asthmatics and correlated with the clinical diagnosis of childhood asthma.Conclusions: FEF25-75% can aid in confirming the diagnosis of suspected asthmatic children who are otherwise not treated as asthmatics and remain undiagnosed in view of not meeting the established spirometry criteria for asthma due to poor performance and ignorance of looking at this important and effort independent parameter.
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Background: Adverse drug reactions (ADRs) are among the leading cause of morbidity and mortality in hospital setup. This study was conducted with the aim of understanding the pattern and occurrence of ADRs to minimize their risk and safeguard public health.Methods: This study is a retrospective analysis of pattern of ADRs reported at ADR monitoring centre (AMC) in a tertiary care hospital. A total of 207 spontaneous ADR reports collected over a period of 18 months were analysed for pattern and type of reactions, demographic profile of patients, organ system affected by ADRs, causative drugs, route of drug administration, severity of reaction, their outcome, management and causality assessment.Results: Most common age group affected by ADRs was 41-50 years with almost equal involvement of male and female gender. Cutaneous reactions involving skin like rashes and itching were most common ADRs. The most common causative drug for ADRs were antimicrobials agents like Penicillin and Cephalosporin group of antibiotics. Orally administered drugs were most commonly involved in causing ADRs. Most of the ADRs belonged to Type A category, were non-serious and moderate in severity. Most of the patients recovered from the ADRs on stopping the suspected drug. On assessing the causality, most of the ADRs were probable with the suspected drugs.Conclusions: Most of the patients recover from ADRs with appropriate and timely intervention, but it is important to understand the pattern and occurrence of ADRs for patient safety and this is possible only with an effective and robust pharmacovigilance system.