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Background: Right ventricular (RV) dysfunction is an important predictor of both immediate and long-term outcomes in valve surgeries. Levosimendan has proven beneficial in improving RV function. Aims: The objective was to study the effect of the addition of levosimendan to the conventional treatment on RV function in patients with RV dysfunction undergoing mitral valve (MV) surgeries. Setting and Design: Prospective randomized double-blinded controlled study at a tertiary care institution. Materials and Methods: Sixty adult patients aged 15� years, with preoperative transthoracic echocardiography (TTE) findings of RV dysfunction posted for elective MV surgery, were randomized into levosimendan (L) group and placebo (P) group. Patients in the L group were administered levosimendan at a rate of 0.1 mcg/kg/min after induction for 24 hrs, whereas patients in the P group were given multivitamin infusion at the same rate. Both the groups received standard inotropic therapy. The hemodynamic and echocardiographic parameters of RV function (RV size, Inferior vena cava (IVC) diameter, RV fractional area change (RVFAC) Tricuspid annular plane systolic excursion (TAPSE), and Systolic Pulmonary Artery Pressure (SPAP) were compared between the groups at 6 hrs, 24 hrs, and 7th day postoperatively. Results: All hemodynamic and echocardiographic parameters of RV function like RV size, IVC diameter, RVFAC, TAPSE, and SPAP improved from baseline to 24 hrs in both groups. Levosimendan caused a significant improvement in RV function compared to the P group at 24 hrs and 7th day postoperatively. Conclusions: The present study concludes that levosimendan is a promising option in patients with RV dysfunction undergoing MV surgeries.
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To enhance the crop production and to manage plant diseases, many chemicals are being used. The use of such agrochemicals is hazardous to environment. To identify a viable alternate, biocontrol agent is necessary. Keeping this in point, the present investigation was undertaken to isolate PGPR bacteria from paddy rhizospheric soil. A total of 100 bacteria were isolated. On the basis of morphological, physiological and biochemical characterisation most of the isolates belong to Pseudomonas aeruginosa. The isolates were further screened for siderophores production by CAS method. In this 10 isolates showed positive results in siderophore production. The produced siderophore were further characterised based on their classi?cation such as hydroxylate, catecholate and carboxamate depending on the iron ligating group. In the present study, the effect of culture media components in the yield of siderophore was studied. Among the 10 isolates, 3 of were produced catecholate type of siderophore ef?ciently in succinate medium at neutral pH in low iron concentration. Potential siderophore producing isolates was further applied on Vigna radiata (Green gram). There was a signi?cant increase in the shoot and root length by roll towel method and Pot assay method
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Background:Ventilator?associated pneumonia (VAP) with multidrug?resistant (MDR) gram negative organisms is a common problem in intensive care unit (ICU). Aerosolized antibiotics enhance the efficacy of systemic antibiotics when added as adjuvants. Aim: The primary objective of the study was to compare the clinical and bacteriological outcome of patients with VAP who were administered intravenous (IV) antibiotics alone with those patients who were treated with adjunctive nebulized colistin (NC) along with IV antibiotics. The secondary objective was to study the occurrence of any adverse events during colistin nebulization. Settings and Design: The study was a prospective, randomized, double?blinded controlled study conducted at a tertiary?care teaching institution. Materials and Methods: Ninety?eight children from surgical ICU aged less than 12 years who were diagnosed with VAP due to gram negative bacteria following cardiac surgery were chosen and divided randomly into two groups. The experimental group (NC group) was treated with systemic antibiotics along with NC, whereas the control group (NS group) was administered systemic antibiotics with nebulized normal saline (NS). Clinical and bacteriological outcomes were noted. Statistical analysis was done using SPSS Version 20.0 software. The patient characteristics were compared using independent Student’s t test and Chi?square test. Results: There was a statistically significant reduction in the duration of mechanical ventilation, postoperative ICU and hospital stay (P < 0.05) in the NC group compared with the NS group. Conclusion: Aerosolized colistin may be considered as an adjunct to systemic IV antibiotics in pediatric patients with VAP due to gram negative bacteria susceptible to colistin.
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Mucormycosis has emerged as an important fungal infection with high associated mortality rates. Mucormycosis causes devastating angio-invasive fungal infections, primarily in patients with underlying risk factors. The prevalence of mortality associated with invasive Mucormycosis is high (>30-50%), with 90% mortality contributed by disseminated disease. Sudden rise in Mucormycosis cases during the COVID-19 pandemic came as a surprise to all. Lowered immunity due to COVID and associated conditions like diabetes, made the population susceptible to this dreaded disease. This disease led to both increase in morbidity and mortality among the general population. Aim of the Study : To interpret in detail the causes of mortality of patients presenting with COVID Associated Mucormycosis (CAM-19) at AIIMS Patna between May-November, 2021. Materials and Methods : An observational study of all patients who were treated for mucormycosis during the period of May 2021-Nov 2021 in ENT Department, AIIMS, Patna. During the period of study, 219 patients of RhinoOrbital-Cerebral Mucormycosis (ROCM) were admitted for treatment. Five patients had gone on Leave Against Medical Advice (LAMA). So, 214 patients were included in the study. Results : Among the 214 patients, 165 patients were treated surgically through both endoscopic and open approaches along with antifungal therapy management. 41 patients died during the hospital course of the treatment. The mortality rate of ROCM stood at 19.15% in our series. Pulmonary Mucormycosis had high mortality (100%). Diabetes is the most common risk factor. Multiple co-morbidities and extensive intracranial involvement had a strong association with mortality. Conclusion : The advanced stage of ROCM was associated with more deaths. Our series mortality rate of 19.15% is lower than most of the other documented mortality rates. Our results support that early aggressive surgical approach, antifungal therapy and multidisciplinary approach has reduced the mortality
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Maternal nutrition and congenital malformation are considered as very important factors for intra uterine growth restriction. Present case deals with these two factors in parallel way. A 32 years young lady second gravida, G2P0A1, housewife, residence of Jaipur, came to NIA OPD with complaint of amenorrhea since a month. According to patient her last menstrual period was on 3/3/20. Her antenatal care was continued in NIA OPD. First fetal wellbeing scan reveals mild ventriculomegaly so she was advised for second level scan and quadruple marker but due to low socioeconomic condition patient was not able to do second level anomaly scan and she continued her pregnancy on her own risk. After 7 months she came to us with the complaints of decreased fetal movements. Fundal height corresponding to period of gestation and fetal heart sound was present which was regular. A color doppler was advised which shows normal fetoplacental and uteroplacental circulation, fetal weight was normal according to period of gestation. On the eighth month the fundal height was found decreased along with maternal weight decreased by 1kg. She was suspected for IUGR and planned for Ksheerbasti. After four episodes Ksheer basti on the 36 weeks of gestation, mother had significant weight gain of 2 kg along with increase in fundal height. USG was done which reveals Single live intra uterine pregnancy of 33 weeks 2 days with lumbar spina bifida with meningomyelocele, CHIARI-II brain malformation, EFW– 2282gm. She delivered a live female child of 2300gm through normal vaginal delivery at maternity hospital. Child was having severe form of myelomeningocele with brain malformation.
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Background: A group of heterogenous entities having the common clinical feature of altered facial pigmentation have been informally called as facial melanoses. Since, the cosmetic disfigurement is easily visible, it has a lot of impact on the psychological well being of the person. To assess the patients of facial hyper Aim: pigmentary disorders for demographic , etiological and clinical profile. A prospective clinical study was conducted in a tertiary care ce Methods: nter in Ananthapuram over period of 6 months. 100 patients with facial hyper pigmentary disorders were assessed by detailed history and clinical examination. In our study, most common age group Results: which sought treatment was 30-50 years. Female were predominantly affected. five different facial melanosis were observed which included melasma, postinfiammatory hyperpigmentation, reihl's melanosis, exogenous ochronosis,topical steroid damaged face. Reihl's melanosis was the most common disorder reported by 30 patients out of 100. Limitations: Dermoscopy could not be done to resource constraint. Conclusion: Increase in awareness and concern with appearance has led to an increase in reported incidence of facial melanosis in both sexes. Prior application of over-the-counter products poses difficulty in correct evaluation and treatment. Psychological evaluation forms an integral part of the treatment of these patients.
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Yellow mosaic virus (YMV) disease is known to cause severe damage in green gram in terms of yield loss. As the resistance is often governed by recessive genes, introgression of such resistance faces some difficulty. DNA molecular markers are reported to be effective in this process. However, validation of such markers is important. Here, we have made an attempt to validate DNA markers associated with YMV disease resistance gene from a diverse group of 26 green gram genotypes. A total of 19 molecular markers were used to assess the susceptibility or resistance against YMV disease. Results show that among the amplified 31 alleles, 21 were polymorphic, with a mean of 1.1.0 per locus. The polymorphism information content (PIC) values ranged from 0.32 to 0.80. Only five markers exhibited higher PIC value (>6.0) and were revealed to be polymorphic, suggesting its utility in marker assisted selection for breeding YMV resistant genotypes in greengram. Dice dissimilarity coefficient among the genotypes exhibited a range of 0.07 to 1.0 which show a wide genetic variation among the genotypes for YMV tolerance. Neighbor-joining cluster analysis has grouped 26 green gram genotypes into 4 main clusters which revealed the existence of genetic dissimilarities among the genotypes. The genotypes AUGG 6, VBN (Gg) 2 and CO (Gg) 8 carried the positive alleles for YMV disease resistance and the allele for susceptibility were found in the genotypes AUGG 12, AUGG 15, AUGG 17 and AUGG 19. Single marker analysis indicated that there was correlation between the markers and the disease reaction in the field with exceptions. The findings revealed that the SSR markers CEDG180 and YR4 could be used to screen germplasm in order to discriminate the YMV resistant genotypes from the susceptible genotypes in marker assisted selection.
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Drought is a predominant factor responsible for yield reduction throughout the world. The current scenario of climate change and global warming are further causing frequent and severe droughts, which emphasizes the need to understand the response of plants to drought stress. Hence, it is imperative to develop a system wherein water utilization is more efficient in agriculture. In this context, the plant root system which is in close association with soil assumes greater importance and they play an important role in plant growth and development by exploiting soil water and nutrients. Root traits such as root diameter, length, specific area, angle, length and density are considered useful traits for improving plant growth under drought conditions. This review on root dynamics under drought stress presented here provides readers with the latest information on root system architecture, genetics, physiology and molecular responses of roots under drought stress.
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Background: We report a case of primary cervical dystocia managed successfully with Ayurveda therapy. The classical Ayurveda lexicons comprise detailed descriptions regarding Prasava (labor) and its management based on which the present case was intervened which resulted in achieving progressive improvement in cervical dilatation and achieving normal labor. Case Presentation: The case reported in this study is primigravidae, 25 years’ old visited prasutitantra OPD, NIA hospital with 37.2 weeks gestational age complaining of labor pains. Since her contraction and per vaginal findings were suggestive of onset of labor, she was hospitalized for further monitoring and awaited spontaneous progress of labor. Repeated Per vaginal examination revealed no progress in cervical dilatation even after 28 hours and she was diagnosed with primary cervical dystocia. Intervention of Kebuka taila yonipichu-25ml 2 hourly was made which resulted in remarkable cervical dilatation equivalent to mean standard rate following 3 interventions of yonipichu within 6 hours. Conclusion: The status of the cervix during labor is a significant determinant of mode and ease of labor. Ayurveda therapeutic strategy of Kebuka taila yoni-pichu can effectively prime the cervix due to the Garbhashayaka sankochaka and estrogenic properties of Kebuka and the activation of Ferguson's reflex by Yoni-pichu.
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Background: Androgen insensitivity syndrome refers to an inability of the body to respond properly to male sex hormones (androgens) produced during pregnancy. This occurs because of a change (mutation) in a gene involved in the production of the protein inside cells that receives the androgen hormone and instructs the cells in how to use it. This is a genetic disorder that makes XY foetuses insensitive (unresponsive) to androgens, they are born looking externally like normal girls and Internally, there is a short blind pouch vagina and no uterus, fallopian tube or ovaries. There are testes in the abdomen or in the inguinal canal. The CAIS is usually detected at puberty when a girl should but does not begin to menstruate. They are at high risk of osteoporosis so should take oestrogen replacement therapy. Case Report: PAIS results in micropenis with hypospadias and gynaecomastia. We report this rare case of 18yr old female patient with primary amenorrhea. Subsequent investigation including karyotyping revealed that the patient is phenotypically female but genotypically male with testes. Gonadectomy was done with proper counselling and patient was put on hormonal replacement replacement therapy.
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Recurrent miscarriages are characterized as three or more spontaneous abortions in a row before the 20th week. In the majority of instances, genetic factors, immunological and endocrine factors, infection, and unknown causes are the most common causes of first trimester abortion. Hormonal therapy, heparin injection, and immunotherapy are the available treatments. In this case study, the patient had three abortions during the first trimester. Because all of the tests came out normal, the diagnosis of unexplained recurrent abortions was made. For 40 days before conception, the patient was treated with Ayurvedic medications such as Indukanta Ghrita, Phalghrita. The patient was conceived with these drugs, and later Phalaghrita and other medicines were given for the duration of the pregnancy. Ayurvedic medicine is an effective way to deal with recurring abortions.
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Objective: To describe the epidemiological features, outcomes and prognostic factors in diagnosis of pediatric hemophagocytic lymphohistiocytosis (HLH). Methods: 118 children fulfilling the inclusion criteria for HLH were identified from review of hospital records for period January, 2010 to December, 2019. Result: Median age at diagnosis was 4 years (range13 days-15 years). Presenting features were fever (100%), hepatosplenomegaly (91%), neurological symptoms (23%), bicytopenia (76%), transaminitis (67.3%), increased soluble interleukin-2 receptor) (sIL-2R) (78%) and hemophagocytosis on bone marrow (75%). Median follow-up duration was 13.5 months (3 days to 102 months). Primary HLH was identified in 27 (23%) patients. Etiology of secondary HLH was infections in 53 (45%), rheumatologic illnesses in 21 (18%) and malignancies in 8 (6%) children. Treatment modalities were steroid only (25%), anti-infectious agent (58%), multi-agent chemotherapy (43%) and HSCT (40%); mortality among above treatment groups were 25%, 58%, 43% and 40%, respectively. 15 patients (13%) had relapsed/refractory HLH who were treated with salvage chemotherapy and hematopoietic stem cell transplantation (HSCT). The overall mortality rate was 39%; mortality within 30 days seen in 23%. Estimated overall survival (OS) and event free survival (EFS) at 3 years were 62% and 61%, respectively. Conclusion: Pediatric HLH is an aggressive disease with high mortality. Hyponatremia, hyperbilirubinemia, coagulopathy and increased sIL2 receptor level at diagnosis predicts poor outcome.
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揋uitar pick sign,� also referred to as posterior globe tenting, is a radiological surrogate marker of tense orbit and profound vision loss. It is seen commonly in traumatic retrobulbar hemorrhage and carotico-cavernous fistula and less frequently in orbital cellulitis, subperiosteal abscess, and invasive fungal infections. We report a case series of Coronavirus disease-19朼ssociated rhino-orbito-cerebral mucormycosis with guitar pick sign, of which none survived, and discuss the causative pathomechanisms, severity grade, and the clinical relevance of this unique radiological finding.
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Introduction: A Doppler ultrasound is a noninvasive test that can be used to estimate the blood flow through the blood vessels by bouncing high-frequency sound waves (ultrasound) off circulating red blood cells. Objective of current study was to determine and compare accuracy of various Doppler parameters for perinatal outcome - Umbilical artery (UA), middle cerebral artery (MCA), and ductus venosus (DV) for predicting adverse perinatal outcome in patients of intrauterine growth retardation. Materials and methods: A total of 172 singleton pregnancies between 33 to 36 weeks of gestation complicated by intrauterine growth restriction were prospectively examined with Doppler ultrasound of the umbilical artery, middle cerebral artery and ductus venosus. Patients kept under surveillance till confinement. According to increasing severity of Doppler indices categorized the cases into six grades from grade 0 to grade 5.Duration of this study was two years, from December 2019 to November 2021. Results: Out of 172 cases, 146 were live born and 26 were neonatal death. There were 7 cases of intrauterine death of fetuses and 5 were still born. Out of the live born 27 had increased perinatal morbidity like poor APGAR score, development of necrotizing enterocolitis, hypoxic ischemic encephalopathy, meconium aspiration syndrome, hyperbilirubinemia, and prolonged admission in neonatal care unit for reasons like sepsis / birth asphyxia. Conclusion: Absent end diastolic flow (EDF) / reversal in umbilical artery had high positive predictive value in predicting adverse fetal outcome. Ductus venosus changes seem to be an ominous sign of a severely compromised fetus with poor perinatal outcome. Doppler investigation of the MCA, UA and DV plays an important role in monitoring the compromised fetuses and helps to determine the optimal time of delivery.
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Introduction: Infertility is a leading psychosocial problem in couples. Diagnostic evaluation of uterine tube is important in the management of infertility. Causes or factors of female infertility can basically be classified regarding whether they are acquired or genetic, age, smoking, sexually transmitted infections (STIs), adhesions in the peritoneal cavity, previous abdomen surgeries, diabetes mellitus, smoking, alcohol, celiac disease, liver and kidney disease and being overweight or underweight can all affect fertility. Proper evaluation of the infertility is needed for better management of the cases of infertility. Aim of the study: To assess the efficacy of Sonosalpingography (SSG) and Hysterosalpingography (HSG) in the diagnosis and management of infertility. Materials and methods: A total 75 cases attending the department with complaint of infertility. Cases between ages 21 years and 44 years were recruited for this study. Duration of this study was two years, from June 2016 to May 2018. All the cases were undergone with baseline transabdominal sonogram, real time transvaginal sonography and saline infusion sonography to examine pelvic region of the cases. All the participants had to undergo SSG on 8th day and HSG on 10th day of the menstrualcycle. Data was collected and sensitivity and specificity of SSG over HSG was assessed. Statistical analysis was done by using SPSS software version 14.0. Results: Diagnosis by SSG showed bilateral tubal patency in 83.93% cases and by HSG showed bilateral tubal patency in 75% cases. SSG and HSG both correlated well (95.3%) and both procedures had similar diagnostic accuracy. In this study, positive predictive value was 95.2% and negative predictive value was 94.6%. Sensitivity was 98.3%, specificity 85.6% and accuracy rate of this study was 95.8%. The outcome of this study indicates that there is no statistically significant difference (p=0.338) between the values of SSG and HSG. Conclusion: SSG is cost effective and radiation free procedure. The outcome of SSG is almost similar to the values of HSG.
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Docosanol is the only US Food and Drug Administration(FDA)approved over-the-counter topical product for treating recurrent oral-facial herpes simplex labialis.Validated analytical methods for docosanol are required to demonstrate the bioequivalence of docosanol topical products.A gas chromatography/selected ion monitoring mode mass spectrometry(GC/SIM-MS)method was developed and validated for docosanol determination in biological samples.Docosanol and isopropyl palmitate(internal standard)were separated on a high-polarity GC capillary column with(88％cyanopropy)aryl-polysiloxane employed as the stationary phase.The ions of m/z 83 and 256 were selected to monitor docosanol and isopropyl palmitate,respectively;the total run time was 20 min.The GC/SIM-MS method was validated in accordance with US FDA guidelines,and the results met the US FDA acceptance criteria.The docosanol calibration standards were linear in the 100-10000 ng/mL concentration range(R2＞0.994).The recoveries for docosanol from the receptor fluid and skin homogenates were＞93.2％and＞95.8％,respectively.The validated method was successfully applied to analyze ex vivo human cadaver skin permeation samples.On applying Abreva?cream tube and Abreva?cream pump,the amount of doco-sanol that penetrated human cadaver skin at 48 h was 21.5±7.01 and 24.0±6.95 ng/mg,respectively.Accordingly,we concluded that the validated GC/SIM-MS was sensitive,specific,and suitable for quantifying docosanol as a quality control tool.This method can be used for routine analysis as a cost-effective alternative to other techniques.
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Cerebral vascular malformations constitute one of the key abnormalities in children with PHACE syndrome, which is characterized by Plaque like cutaneous hemangiomas, Posterior fossa abnormalities, arterial Cerebrovascular and Eye abnormalities, with or without Sternal clefts (PHACES when sternal clefts are present), and associated midline anomalies. Both moyamoya arteriopathy and intracranial aneurysms have been reported in children with this syndrome. Herein, we report the successful treatment of a growing left posterior-communicating artery aneurysm arising from an aberrant left internal carotid artery (LICA) with balloon assisted coiling (BAC) in a child with PHACE syndrome. We circumvented the limitations posed by the narrow caliber of the proximal LICA, by successfully navigating a coiling microcatheter from the basilar artery into the LICA via a persistent trigeminal artery. BAC was then achieved using a Scepter Mini balloon microcatheter for aneurysm neck remodelling.
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Cerebral vascular malformations constitute one of the key abnormalities in children with PHACE syndrome, which is characterized by Plaque like cutaneous hemangiomas, Posterior fossa abnormalities, arterial Cerebrovascular and Eye abnormalities, with or without Sternal clefts (PHACES when sternal clefts are present), and associated midline anomalies. Both moyamoya arteriopathy and intracranial aneurysms have been reported in children with this syndrome. Herein, we report the successful treatment of a growing left posterior-communicating artery aneurysm arising from an aberrant left internal carotid artery (LICA) with balloon assisted coiling (BAC) in a child with PHACE syndrome. We circumvented the limitations posed by the narrow caliber of the proximal LICA, by successfully navigating a coiling microcatheter from the basilar artery into the LICA via a persistent trigeminal artery. BAC was then achieved using a Scepter Mini balloon microcatheter for aneurysm neck remodelling.
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The use of aromatherapy for the reduction of anxiety levels during dental treatment procedures has been well established in the literature; however, there is limited evidence regarding its efficacy. The present meta-analysis is an attempt to assess the association between the use of aromatherapy and anxiety levels among dental patients.A comprehensive search was conducted across Medline, Scopus, Web of Science, EBSCO host, Cochrane databases, and Google Scholar for studies evaluating aromatherapy and anxiety level among dental patients. PRISMA guidelines were followed for the meta-analysis. Randomized and cluster-randomized trials comparing aromatherapy with controls were included. The random-effects model was used to assess the mean differences in anxiety levels of patients visiting dental OPD. The significance value was set at P < 0.05. Six studies were identified that met the requirements for inclusion. Aromatherapy was significantly associated with reduction in patient anxiety levels during dental treatment (pooled mean difference: -3.36 [95% CI, -3.77 – -2.95, P = 0.00001). Low heterogeneity was noted between studies (I2 = 1%, P = 0.41) analyzed in the meta-analysis. High certainty of the evidence was obtained from the association between the use of aromatherapy and dental anxiety. This meta-analysis suggests that aromatherapy is effective in reducing dental anxiety. When used judiciously, the results of this work should encourage the use of aromatherapy to reduce patient anxiety levels during dental procedures
ABSTRACT
The use of aromatherapy for the reduction of anxiety levels during dental treatment procedures has been well established in the literature; however, there is limited evidence regarding its efficacy. The present meta-analysis is an attempt to assess the association between the use of aromatherapy and anxiety levels among dental patients.A comprehensive search was conducted across Medline, Scopus, Web of Science, EBSCO host, Cochrane databases, and Google Scholar for studies evaluating aromatherapy and anxiety level among dental patients. PRISMA guidelines were followed for the meta-analysis. Randomized and cluster-randomized trials comparing aromatherapy with controls were included. The random-effects model was used to assess the mean differences in anxiety levels of patients visiting dental OPD. The significance value was set at P < 0.05. Six studies were identified that met the requirements for inclusion. Aromatherapy was significantly associated with reduction in patient anxiety levels during dental treatment (pooled mean difference: -3.36 [95% CI, -3.77 – -2.95, P = 0.00001). Low heterogeneity was noted between studies (I2 = 1%, P = 0.41) analyzed in the meta-analysis. High certainty of the evidence was obtained from the association between the use of aromatherapy and dental anxiety. This meta-analysis suggests that aromatherapy is effective in reducing dental anxiety. When used judiciously, the results of this work should encourage the use of aromatherapy to reduce patient anxiety levels during dental procedures