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Objectives@# Prophylactic vaccines against high-risk human papillomaviruses (HR-HPVs) hold promise to prevent the development of higher grade cervical intraepithelial neoplasia (CIN 2+) and cervical cancer (CC) that develop due to HR-HPV genotypes that are included in HPV vaccines, but women will continue to develop CIN 2+ and CC due to HR-HPV genotypes that are not included in the quadrivalent HPV vaccine (qHPV) and 9-valent HPV vaccine (9VHPV). Thus, the current vaccines are likely to decrease but not entirely prevent the development of CIN 2+ or CC. The purpose of the study was to determine the prevalence and determinants of CIN 2+ that develop due to HR-HPVs not included in vaccines. @*Methods@# Study population consisted of 1476 women tested for 37 HPVs and known to be negative for qHPVs (6/11/16/18, group A, n = 811) or 9VHPVs (6/11/16/18/31/33/45/52/58, group B, n = 331), but positive for other HR-HPVs. Regression models were used to determine the association between plasma concentrations of micronutrients, socio-demographic, lifestyle factors and risk of CIN 2+ due to HR-HPVs that are not included in vaccines. @*Results@# The prevalence of infections with HPV 31, 33, 35 and 58 that contributed to CIN 2+ differed by race. In group A, African American (AA) women and current smokers were more likely to have CIN 2 (OR = 1.76, P = 0.032 and 1.79, P = 0.016, respectively) while in both groups of A and B, those with higher vitamin B12 were less likely to have similar lesions (OR = 0.62, P = 0.036 and 0.45, P = 0.035, respectively). @*Conclusions@# We identified vitamin B12 status and smoking as independent modifiable factors and ethnicity as a factor that needs attention to reduce the risk of developing CIN 2+ in the post vaccination era. Continuation of tailored screening programs combined with non-vaccine-based approaches are needed to manage the residual risk of developing HPVrelated CIN 2+ and CC in vaccinated women.
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Introduction: Vitamin D deficiency and Obesity are the two prevailing health issues of the globe, with India being no excep?on. The sub op?mal Vitamin D levels is associated with an elevated risk of a number of chronic disorders including malignancy, inflamma?on and autoimmune diseases. Obesity breeds metabolic disharmony. Recent data reports Vitamin D deficiency being more prevalent among the obese. Objec?ve: This study is undertaken to see the associa?on of Vitamin D levels with Body Mass Index (BMI), Lipid parameters and Insulin resistance in a sample popula?on represen?ng the urban Indian youth. Materials and Method: Fi?y five apparently healthy young adults of 18 to 22 years age were recruited in this study and their serum 25-hydroxycholecalciferol(25OHD), serum insulin, Total Cholesterol, High Density lipoproteincholesterol (HDL-c), Low Density lipoprotein- cholesterol (LDL-c) and Triglyceride (TGL) levels were es?mated. Insulin resistance(IR) was derived using the Homeostasis Model Assessment equa?on. Based on BMI, the par?cipants were divided into Obese group with BMI ? 25 (n=21) and nonobese group with BMI < 25 (n=34). Result: 25OHD levels were almost same in both Groups (Obese11.1 ± 4.6 ng/ml and non-obese 11.0 ± 5.2 ng/ml). Serum total cholesterol, VLDL and insulin levels were significantly increased in the Obese group(p= 0.005, p= 0.015 and p=0.054 respec?vely) when compared to the non-obese group. We found sta?s?cally significant associa?on between 25-hydroxycholecalciferol (25OHD) and TGL/HDL ra?o in the Obese group. Conclusion: In this pilot study we have unravelled the subtle onset of metabolic derangement in Obese individuals with Vitamin D deficiency.
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Justification: Suicide is an important cause of adolescent mortality and morbidity in India. As pediatricians are often the first point of contact for adolescents and their families in the healthcare system, they need guidelines to screen, assess, manage and prevent adolescent suicidal behavior to ensure survival, health and mental well-being of this vulnerable population. Objectives: To formulate guidelines to aid pediatricians for prevention and management of adolescent suicidal behavior. Process: Indian Academy of Pediatrics, in association with Adolescent Health Academy, formed a multidisciplinary committee of subject experts in June, 2019 to formulate guidelines for adolescent suicide prevention and management. After a review of current scientific literature and preparation of draft guidelines, a national consultative meeting was organized on 16 August, 2019 for detailed discussions and deliberations. This was followed by refining of draft guidelines, and discussions over e-mail where suggestions were incorporated and the final document was approved. Guidelines: Pediatricians should screen for mental distress, mental disorders and suicidal and para-suicidal (non-suicidal self-injury) behavior during adolescent health visits. Those with suicidal behavior should be referred to a psychiatrist after providing emergency healthcare, risk assessment, immediate counselling and formulation of a safety plan. Pediatricians should partner with the community and policymakers for primary and secondary prevention of adolescent suicide.
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Background: Hemodynamic stability is an important aspect to the anesthesiologist for patients. Laryngoscopy and endotracheal intubation can cause striking changes in Hemodynamics as result of intense stimulation of sympathetic nervous system. ProSeal LMA (PLMA)minimizes this response without compromising the airway. The aim of this study was to compare PLMA and Endotracheal tube with respect to intra-operative hemodynamic responses in patients undergoing general anaesthesia. Material and Methods: This prospective observational study was conducted on 30 patients of either sex, age group of 18-60 years, ASA (I or II), Mallam Pati (I or II) posted for elective surgery under general anaesthesia. They were randomly divided into two group 15 each. For group A, airway was secured with laryngoscopy and intubation with appropriate size endotracheal tube and for group B, appropriate size PLMA was inserted to secure airway. The hemodynamic responses like Heart rate and Blood pressure were recorded at base line, at insertion, after 1st min, 3rd min, 5th min and after extubation. Mean increase was statistically more after endotra Results: cheal intubation than PLMA insertion. The elevation in these hemodynamic parameters significantly persisted for a longer period of time in the ETT group, where it returned to the baseline value by 5 minutes as compared to the PLMA group where it returned by 3 minutes. The hemodynamic res Conclusion: ponse produced when PLMA was used for securing airway was less than the laryngoscopy and endotracheal intubation. Thus, PLMA proved to be a suitable alternative to endotracheal tube for airway management with stable hemodynamic.
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To evaluate phytochemical, heavy metal, pesticide, microbial assay, and also FTIR studies of Angiatico-2 (A-2) an Electrohomeopathic remedy to evaluate safety and efficacy for its usage. Electrohomeopathy / Electropathy is one purely herbal medical system invented by Italian C. C. Mattie (1809-1896) has been practiced since the 1860s across the world. Electrohomeopathy has its own unique principles, plants selection, the process of remedies preparation, diagnosis, selection, and combination of drugs for different diseases, dosage, and treatment methods. In India, it is estimated that there are about 450-500 institutions imparting education and research, about 4.5 to 5 lacks practitioners are practicing and millions of population getting benefits currently. The government of India initiated steps to recognize Electrohomeopathy medical system under the constitution. Unfortunately, there is very limited scientific evidence to evaluate the safety, efficacy, phytochemical, and pharmacology studies in Electrohomeopathy. We prepared Angiatico-2 an Electrohomeopathic remedy as Mother Solution and D4 dilutions and evaluated it’s phytochemical screening, TLC, FTIR spectrum, Physical and Chemical nature, presence or absence of heavy metals, Pesticide, Food Additives and Microbial under NABL standards for its safety usage. Electrohomeopathic herbal remedy Angiatico-2 prepared by using 7 non poisonous plants by Krauss method under standard condition and not shown any heavy metals, pesticide presence and also no microbial presence above the limit level of FSSAI standard. Present studies of Electrohomeopathic herbal remedy Angiatico-2 preparation and its screening in standard scientific laboratory condition, TLC & FTIR studies may become reference standards for the manufacture of Angiatico-2 for bulk quantity at industrial level for. The present research investigations outcome with reproducibility may become standard markers or signatures to assess the quality and safe use of Angiatico-2.
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Justification: Adolescent health is critical to the current and future well- being of the world. Pediatricians need country specific guidelines in accordance with international and national standards to establish comprehensive adolescent friendly health services in clinical practice. Process: Indian Academy of Pediatrics (IAP) in association with Adolescent Health Academy formed a committee of subject experts in June, 2019 to formulate guidelines for adolescent friendly health services. After a review of current scientific literature and drafting guidelines on each topic, a national consultative meeting was organized on 16 August, 2019 for detailed discussions and deliberations. This was followed by discussions over e-mail and refining of draft recommendations. The final guidelines were approved by the IAP Executive Board in December, 2021. Objective: To formulate guidelines to enable pediatricians to establish adolescent friendly health services. Recommendations: Pediatricians should coordinate healthcare for adolescents and plan for transition of care to an adult physician by 18 years of age. Pediatricians should establish respectful, confidential and quality adolescent friendly health services for both out-patient and in-patient care. The healthcare facility should provide preventive, therapeutic, and health promoting services. Pediatricians should partner with the multidisciplinary speciality services, community, and adolescents to expand the scope and reach of adolescent friendly health services.
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BACKGROUND@#Tissue engineering centers on creating a niche similar to the natural one, with a purpose of developing an organ construct. A natural scaffold can replace none while creating a scaffold unique to each tissue in composition, architecture and cues that regulate the character of cells. @*METHODS@#Whole pancreas from mouse was decellularized using detergent and enzymes, followed by recellularizing with MSC from human placenta. This construct was transplanted in streptozotocin induced diabetic mice. Histopathology of both decellularized and recellularized transplanted pancreas and qPCR analysis were performed to assess its recovery. @*RESULTS@#Decellularization removes the cells leaving behind extracellular matrix rich natural scaffold. After reseeding with mesenchymal stem cells, these cells differentiate into pancreas specific cells. Upon transplantation in streptozotocin induced diabetic mice, this organ was capable of restoring its histomorphology and functioning. Restoration of endocrine (islets), the exocrine region (acinar) and vascular network was seen in transplanted pancreas. The process of functional recovery of endocrine system took about 20 days when the mice start showing blood glucose reduction, though none achieved gluconormalization. @*CONCLUSION@#Natural decellularized scaffolds of soft organs can be refunctionalized using recipient’s mesenchymal stem cells to restore structure and function; and counter immune problems arising during transplantation.
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BACKGROUND@#Tissue engineering centers on creating a niche similar to the natural one, with a purpose of developing an organ construct. A natural scaffold can replace none while creating a scaffold unique to each tissue in composition, architecture and cues that regulate the character of cells. @*METHODS@#Whole pancreas from mouse was decellularized using detergent and enzymes, followed by recellularizing with MSC from human placenta. This construct was transplanted in streptozotocin induced diabetic mice. Histopathology of both decellularized and recellularized transplanted pancreas and qPCR analysis were performed to assess its recovery. @*RESULTS@#Decellularization removes the cells leaving behind extracellular matrix rich natural scaffold. After reseeding with mesenchymal stem cells, these cells differentiate into pancreas specific cells. Upon transplantation in streptozotocin induced diabetic mice, this organ was capable of restoring its histomorphology and functioning. Restoration of endocrine (islets), the exocrine region (acinar) and vascular network was seen in transplanted pancreas. The process of functional recovery of endocrine system took about 20 days when the mice start showing blood glucose reduction, though none achieved gluconormalization. @*CONCLUSION@#Natural decellularized scaffolds of soft organs can be refunctionalized using recipient’s mesenchymal stem cells to restore structure and function; and counter immune problems arising during transplantation.
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Background: Expectant management as first line management of early pregnancy miscarriages is less accepted due to failure and increased complications reported in few studies. Proper selection of cases improves outcome of expectant management. Aim of this study was to compare success rate and complications in expectant management in three groups of early pregnancy miscarriages- Incomplete miscarriage, anembryonic pregnancy and early fetal demise.Methods: Prospective observational study conducted in tertiary care centre for 3 years, including 107 patients with USG confirmed pregnancy miscarriage <13 weeks. Patients preferring expectant management were managed as outpatient without intervention for 2 weeks after which repeat USG was done to ascertain complete miscarriage. Failed expectant management patients underwent planned surgical uterine evacuation. Emergency admission and evacuation was done, if symptomatic during waiting period. Success rate and complications like emergency evacuation, vaginal bleeding, abdominal pain, limitation of physical activity and patient satisfaction were assessed and compared in subgroups of anembryonic pregnancy, early fetal demise and incomplete miscarriage. Statistical analysis was done by chi-square test.Results: Incomplete miscarriage group had highest success rate of 88.46%. followed by anembryonic pregnancy (72.5%) and EFD (47.83%) p value = 0.007. Complication rate was highest in EFD, followed by anembryonic and the least in incomplete miscarriage all of which was statistically significant except vaginal bleeding.Conclusions: Expectant management should be offered as first line choice for all types of early pregnancy miscarriages. Proper selection of case as to type of miscarriage especially incomplete miscarriage and selected cases of anembryonic pregnancy and EFD ensures higher success rate with lesser complications. Reserving medical and surgical management for unsuitable/failed cases.
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Pharmaceutical compounds have been recognized as a hazardous class of organic pollutants due to their long term effects towards the aquatic environment. The present work studies the efficiency of electrogalation (EC) process in removal Norfloxacin (NFX) from aqueous solutions by aluminum electrodes. This study experimentally was run in a batch electrochemical reactor (1.5 L glass beaker)and six electrodes which installed in parallel. In each of test, 1 L of wastewater added tothetest reactor, then effect of four parameters including the voltage 10-60 V (current density: 1,2,3 and 4 mA/cm2), reaction time (5-60 min) initial concentration of NFXand the pH of wastewater (pH=3-9) on process performance were investigated. Results of this study showed that the efficiency of the system could be promoted by increasing the contact time, initial pH of the solution, and the applied voltage. However, the efficiency of EC process has decreased, when higher level of NFX ions was presented in the aqueous phase.The optimal conditions for Norfloxacin removal were: pH 7, initial NFX concentration 25 mg/L, voltage 60 V and reaction time 45 min and the highest removal rate was under these conditions 98.4%. The results of this study indicate that EC process could be applied for the removal of NFX from aqueous solution with a high efficiency
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Introdcution: Paratubal atypical proliferative serous tumoursare rare usually arising from the mesothelium or from theremnants of mesonephric and paramesonephric ducts. Wepresent a rare case of paratubal borderline serous tumour in ayoung adolescent female presenting clinically as an omentalcyst.Case Report: A 14-year old unmarried female presentedwith abdominal pain in right iliac fossa. MRI revealed awell demarcated space occupying lesion in the pelvis almostin midline measuring 12x11x8cm. Lesion was abutting anddisplacing overlying bowel loops with likely adhesionssuggestive of complex omental cyst. The patient underwentcystectomy. The final histopathologic report confirmed thecyst as Paratubal atypical proliferative serous tumour.Conclusion: We experience a rare case of atypical proliferativeserous tumour of paratubal origin. The patient was youngestthan any of the other cases reported in the literature. Fertilitysparing surgery should be considered as a standard treatmentof borderline paratubal tumour, if patient desires futurefertility.
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Introduction: Hypertension is an important public healthproblem both in developed and developing countries.Hypertension is known to be associated with alterations inlipid metabolism which gives rise to abnormalities in serumlipid and lipoprotein levels but the cause and effect relationshipis not known. The study was initiated with objective to assessthe lipid profile abnormalities among primary hypertensivepatients attending tertiary care center.Material and Methods: A case control study was done inoutpatient department (OPD) of General medicine, GITAMInstitute of Medical Sciences & Research, Visakhapatnamduring May to October 2019. A total of 200 study participantswere included based on inclusion & exclusion criteria, 100were primary hypertensive cases and 100 were age and gendermatched controls. After obtaining approval from InstitutionalEthics Committee and informed consent taken from all studyparticipants data was collected. Data entered in MS excelsheet and analyzed by using SPSS software.Results: Out of 200 study participants 88(44%) were femaleand 112(56%) were male. Majority of the study participantswere in the age group 50 to 70 years. The mean values of thetotal cholesterol, low density lipoprotein (LDL) cholesterol,and triglycerides were significantly higher in hypertensivepatients compared to control group. The mean high densitylipoprotein (HDL) cholesterol was lower among cases thancontrols. These differences were found to be statisticallysignificant.Conclusion: Dyslipidemia and hypertension in combinationincreases the risk of cardiovascular diseases, stroke etc. Henceearly detection of dyslipidemia in hypertensive patients andaggressive treatment of both the conditions should be carriedout to prevent complications.
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Introduction: Despite the advancement in medicine,management of heart failure (HF), which usually presentsas a disease syndrome, has been a challenge to healthcareproviders. The study was commenced with objective tostudy the profile of patients presented with heart failure withreduced left ventricular ejection fraction (LVEF) in a tertiarycare hospital.Material and Methods: It was a cross sectional hospitalbased study. Both male and female patients presented withheart failure with reduced ejection fraction (HFrEF) treated indepartment of General Medicine, GITAM Institute of MedicalSciences & Research were included based on inclusion andexclusion criteria. A total of 100 consecutive patients werestudied during February to October 2019. After obtainingapproval from Institutional Ethics Committee and informedconsent taken from all study participants data was collected.Data entered in MS excel sheet and analyzed by using SPSSsoftware.Results: Among total 100 heart failure patients males were69, females were 31. The mean age of study population was56.61±13.01 years. All patients presented with shortness ofbreath of varying degree of New York Heart Association(NYHA) class. The common risk factors observed werehypertension (53%), diabetes (36%), alcohol (14%), smoking(40%). The common causes for heart failure found wereIschemic heart disease (64%), followed by non-ischemicdilated cardiomyopathy (21%) and rheumatic heart disease(15%). Majority of the study participants were receivingtreatment with diuretics (66%), statins (65%), followed bybeta blockers (25%), aldosterone antagonist (25%), ACEinhibitors (30%).Conclusions: Early detection and optimal treatment ofcommon risk factors might play role in preventing Heartfailure and thereby reducing disease burden in the country
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Background: Postpartum blood loss is difficult to evaluate especially in developing countries like India where most of the women are anaemic with poor reserve and these conditions are further aggravated by increased demand during pregnancy and blood loss during third stage of labour. The present study was planned to compare the efficacy of prophylactic 10 IU intramuscular oxytocin and 10 IU intramuscular oxytocin +1g Tranexamic acid in reducing blood loss in the third stage of labour.Methods: The present study was carried out on full term pregnancies primigravida/ multiparas with singleton pregnancy being delivered vaginally at GSL Hospital, Rajahmundry between 2016-2017 were included. For this comparative study, 200 women in labor were included after obtaining informed consent. A detailed obstetric history, history of previous medical illnesses, history of the treatment received earlier, cardiovascular and respiratory system and other systems including thyroid and breast were noted.Results: The average total blood loss in IIIrd stage of labour with IM oxytocin was 210 ml and with IM oxytocin + Tranexamic acid was130 ml, which was statistically significant (p<0.001). Oxytocin + Tranexamic acid group had less blood loss when compared to oxytocin group alone. Side effects like, nausea vomiting, headache were slightly more with oxytocin + Tranexamic acid group when compared to oxytocin group alone.Conclusions: In the active management of IIIrd stage of labour 10 IU intramuscular Oxytocin + one gram of tranexamic acid IV is a better combination in reducing the blood loss at delivery when compared to 10 IU intramuscular oxytocin alone.
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Induction of labor is the artificial initiation of labor before its spontaneous onset for the purpose of delivery of the feteplacental unit using mechanical or pharmacologic methods.The success of labor induction depends on the cervical status at the time of induction. About 20% of pregnant women will have labour induced for variety of reasons. Methods:This was a comparative prospective study on 90 patients at term for induction of labour. The patients were categorized into two groups – Group A and Group B in each group – 25mcg oral / 25mcg vaginal misoprostol was given. Results: The mean age of patients was 27.42±8.6 years in oral group A, 25.52±6.23 years in in the vaginal group B (p=0.48). The mean period of gestation was 38.23±11.24 weeks in the oral group A, 38.87±12.02 weeks in in the vaginal group B (p=0.58). The mean Bishop was 3.43±0.73 in oral group A, and 3.51±0.49 in the vaginal group B (p= 0.37). Conclusion: Induction of labor, oral misoprostol 25mcg is as effective as vaginal misoprostol 25mcg for induction of labour at term with minimal maternal and fetal complications.
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Introduction: The communication between musculocutaneous nerve and median nerve is an important anatomicalvariation to occur having serious implications during surgical procedures on arm if unnoticed and without priorknowledge.Materials and Methods: The present study was conducted in 80 upper limbs of 40 adult human cadavers (Female:10 and Male: 30) in the Department of Anatomy, Siddhartha Medical College (Government), Vijayawada and theDepartment of Anatomy, N.R.I. Medical College, Guntur over a period of 4 years (2014 to 2018) during educationaldissections.Results: The communication between musculocutaneous nerve and median nerve was observed in present study,which is classified in accordance with previous classifications described in the literature. In present study theincidence of communication between musculocutaneous nerve and median nerve is 25%.Conclusion: Prior knowledge of this communication between musculocutaneous and median nerves in the arm isimportant to avoid the surgical damage to the nerves and also explain unusual clinical presentation in shoulderinjuries
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@#Diarrhoea is a leading killer of children, accounting for 9% of all deaths among children under age 5 worldwide and 3% in Malaysia in 2015. A large proportion of diarrhoea illnesses among children in developing countries are ascribed to an unknown etiology because microscopic examination was the only available technique which has low detection limits. The proposed study aimed to evaluate a new quadriplex PCR assay to detect parasitic pathogens namely E. histolytica, G. lamblia and C. parvum which considered responsible for the majority of human infections. Three set of specific primer pairs were designed for detection of parasitic pathogens. Quadriplex PCR assay was optimized and an internal amplification control was incorporated to check for PCR inhibitors in samples. The PCR assay was evaluated using spiked stool samples. Specific primer pairs were successfully designed and simultaneously amplified the targeted genes. The analytical sensitivity of the quadriplex PCR at the DNA level was found to be 50 ng DNA. The analytical specificity was evaluated with 11 reference protozoal and bacterial strains and was found to be 100%. We concluded that the developed quadriplex PCR assay was rapid and gave results within 5 hours which is essential for the identification of parasitic pathogen and might be useful as an additional diagnostic tool whenever time is important in the diagnosis of parasite that cause diarrhoea.
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Objective: To compare anti-HBs titers between term low birthweight (1800-2499 g) infants and normal birthweight infants, 6weeks after last dose of primary immunization with pentavalentvaccine, and to study adverse events following immunization(AEFI) with pentavalent vaccine.Design: Cohort study.Setting: Tertiary-care hospital predominantly catering to urbanpoor population of East Delhi.Participants: 265 low birthweight (1800-2499 g) and 265 normalbirthweight (2500-4000 g) infants. Monovalent Hepatitis B vaccinewas administered within 24 hours of birth followed by three primarydoses of pentavalent vaccine at 6, 10 and 14 weeks. Anti-HBstiters were estimated after 6 weeks of third dose of pentavalentvaccine. Adverse events following immunization (AEFI) monthwere observed for a month after each dose of pentavalent vaccine.Main outcome measures: Anti HBs antibody titers after 6 weeksof primary immunization, and AEFI.Result: 443 (83.5%) infants (225 low birthweight and 218 normalbirthweight infants) completed the follow-up. Seroprotectionagainst hepatitis B virus was achieved in both groups afterpentavalent vaccine administration. Anti HBs GMTs in lowbirthweight infants (194.8 mIU/mL) and normal birthweight infants(204.2 mIU/mL) were comparable (P = 0.17). No serious adverseevents were observed in either group.Conclusion: Three primary doses of pentavalent vaccineadministered along with zero dose of Hepatitis B vaccine at birthprovide good seroprotection. The vaccine appears to be safe inboth low birth weight and normal birthweight infants born at term.
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Introduction: Diverse Factors influence medical student’s choice of eventual careers. Community Medicine is one of the specialities taken up at various hospitals by a number of doctors. This study was planned to review the career opportunities taken by doctors who passed MD Community Medicine or Diploma in Public Health from a premier teaching college located in Mumbai, Maharashtra. Results: 163 students were enrolled since 2009 off which 53 were currently pursuing either MD/DPH course. Data was collected for this study in the months of September 2017 to November 2017. The career profile were grouped as Academics in MCGM, Academics in State government colleges, Public health in MCGM, state, centre, etc. Most pursued current careers were Speciality Medical Officer (bond post) in MCGM colleges (16), Academic positions in State government colleges (16), public health positions in Maharashtra state government (13) and public health in MCGM (11). Very few candidates were currently working in international or national institutions. Conclusion: This study shows that Academics and Public Health still are the major career prospects for doctors who have done MD/DPH. It could be seen that very few opted for other career options like Preventive Oncology, Health Management or Research institutes. This study recommends better maintenance of records of alumni for future contacts and career counselling for post graduate students.