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Objective: Identifying clinical and laboratory indicators that differentiate multisystem inflammatory syndrome in children (MIS-C) apart from other febrile diseases in a tropical hospital setting. Methods: Review of hospital records done in a tertiary care exclusive children’s hospital for children admitted from April, 2020 till June, 2021. Laboratory values, severe acute respiratory syndrome coronavirus (SARS-CoV-2) serological status, and clinical signs and symptoms of patients with MIS-C, and those with similar presentations were analyzed. Results: 114 children fulfilled the inclusion criteria (age group of 1 mo-18 y) for whom a diagnosis of MIS-C was considered in the emergency room based on the clinical features. Among them, 64 children had the final diagnosis of MIS-C, and the remaining 50 children had confirmatory evidence of infections mimicking MIS-C such as enteric fever, scrub typhus, dengue and appendicitis. Conclusion: Older age group, presence of mucocutaneous symptoms, very high C-reactive protein, neutrophilic leukocytosis, abdominal pain and absence of hepatosplenomegaly favor a diagnosis of MIS-C.
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Purpose: The aim of this study was to elucidate the type of low vision devices (LVDs) prescribed for patients with cone dystrophy, cone–rod dystrophy, and rod–cone dystrophy and to analyze the visual improvement with the devices. Methods: A retrospective review of 300 electronic medical records of patients with cone dystrophy, cone–rod dystrophy, and rod–cone dystrophy referred to the low vision care (LVC) clinic for the first time between 2014 and 2016 at a tertiary eye care center was done. Collected data included the demographic profile of patients, details of LVDs, and best?corrected vision. Results: Out of 300 patients, 62.6% (n = 188) were male and 37.3% (n = 112) were female. Of the cases, 50% (n = 150) had cone–rod dystrophy, 45% (n = 135) had cone dystrophy, and 5% (n = 15) had rod–cone dystrophy. The most commonly prescribed LVD was SEE?TV binocular telescope (n = 6, 2.0%) for distance and dome magnifier (n = 60, 20%) for near. ET?40 dark grey tint (20.6%) was preferred for managing photophobia. There was a statistically significant difference in both distance and near visual acuities with LVDs (P < 0.05) in all categories, except rod–cone dystrophy. Conclusion: Early diagnosis with appropriate prescription of LVDs including tints helps in achieving good quality of vision in patients with cone?related dystrophies.
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Metabolic syndrome (MetS) involves multi-factorial conditions linked to an elevated risk of type 2 diabetes mellitus and cardiovascular disease. Pre-metabolic syndrome (pre-MetS) possesses two MetS components but does not meet the MetS diagnostic criteria. Although cardiac autonomic derangements are evident in MetS, there is little information on their status in pre-MetS subjects. In this study, we sought to examine cardiac autonomic functions in pre-MetS and to determine which MetS component is more responsible for impaired cardiac autonomic functions. A total of 182 subjects were recruited and divided into healthy controls (n=89) and pre-MetS subjects (n=93) based on inclusion and exclusion criteria. We performed biochemical profiles on fasting blood samples to detect pre-MetS. Using standardized protocols, we evaluated anthropometric data, body composition, baroreflex sensitivity (BRS), heart rate variability (HRV), and autonomic function tests (AFTs). We further examined these parameters in pre-MetS subjects for each MetS component. Compared to healthy controls, we observed a significant cardiac autonomic dysfunction (CAD) through reduced BRS, lower overall HRV, and altered AFT parameters in pre-MetS subjects, accompanied by markedly varied anthropometric, clinical and biochemical parameters. Furthermore, all examined BRS, HRV, and AFT parameters exhibited an abnormal trend and significant correlation toward hyperglycemia. This study demonstrates CAD in pre-MetS subjects with reduced BRS, lower overall HRV, and altered AFT parameters. Hyperglycemia was considered an independent determinant of alterations in all the examined BRS, HRV, and AFT parameters. Thus, hyperglycemia may contribute to CAD in pre-MetS subjects before progressing to MetS.
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A simple and reliable strategy was proposed to engineer the glutathione grafted graphene oxide/ZnO nanocomposite(glutathione-GO/ZnO)as electrode material for the high-performance piroxicam sensor.The prepared glutathione-GO/ZnO nanocomposite was well characterized by X-ray diffraction(XRD),Fourier transform infrared spectrum(FTIR),X-ray photoelectron spectroscopy(XPS),field emission scanning electron microscopy(FE-SEM),cyclic voltammetry(CV),electrochemical impedance spectros-copy(EIS)and differential pulse voltammetry(DPV).The novel nanocomposite modified electrode showed the highest electrocatalytic activity towards piroxicam(oxidation potential is 0.52 V).Under controlled experimental parameters,the proposed sensor exhibited good linear responses to piroxicam concentrations ranging from 0.1 to 500 μM.The detection limit and sensitivity were calculated as 1.8 nM and 0.2 μA/μM·cm2,respectively.Moreover,it offered excellent selectivity,reproducibility,and long-term stability and can effectively ignore the interfering candidates commonly existing in the pharmaceutical tablets and human fluids even at a higher concentration.Finally,the reported sensor was successfully employed to the direct determination of piroxicam in practical samples.
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Mycoplasma is a frequent cause of community acquired pneumonia in children accounting for 20 percent of the cases. Though CNS complications are the most common extra pulmonary manifestations of M. pneumoniae stroke is a rare entity. Here we report a case of 7 years old male child with macrolide resistant M. pneumoniae complicated pneumonia that developed right hemiparesis and dysphasia. Brain magnetic resonance imaging and angiography showed left fronto parietal infarct and left carotid artery stenosis. He responed to non-macrolide antimicrobial regimen. This potential yet rare complication should be considered and closely monitored for in children presenting with complicated pneumonia.
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Takayasu arteritis is a relatively rare type of large-vessel arteritis that primarily affects the aorta and its major branches, the coronary arteries, and the pulmonary arteries. Depending on the different groups of blood vessels involved in the disease process, the clinical presentation of Takayasu arteritis varies. Here we report a case of a girl presenting with a debilitating massive cerebral ischemic infarct that turned out to be a relatively rare first presentation of Takayasu arteritis. Case report of 15 years old adolescent female hailing from lower socio-economic status with past history of chronic headache, no significant family history, completely immunized presented with sudden onset weakness of right upper and lower limbs, which progressed over 1day with aphasia (recovering) with deviation of angle of mouth to left side On examination left radial ,carotid artery not palpable. Her laboratory results showed an elevated C-reactive protein and erythrocyte sedimentation rate, and subsequent CT angiography demonstrated narrowing and occlusion of the major branches of her aortic arch. We report the case of a patient with Takayasu arteritis presenting with a massive cerebral ischemic infarct and review the current literature on this topic. Conclusion of takayasu arteritis is a relatively rare disease with various and sometimes devastating clinical manifestations, such as massive cerebral ischemic infarction as in our case. Currently, there are multiple diagnostic tools and treatment options available, and more under investigation. Early, appropriate diagnosis and initiation of proper therapy could avoid further progression and reduce complications of the disease.
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Lawrence syndrome (Acquired Generalized Lipodystrophy) is a rare disorder, characterized by various dermatological and systemic manifestations such as lipodystrophy, hypertriglyceridemia, hepatomegaly, acanthosis nigricans and acromegaloid features. Because of its rare occurrence we are reporting a case with similar manifestations in a 10 years old child.
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Aims and Objectives: Adequate knowledge, attitude, and practices toward antibiotic usage and resistance among health caregiver are the need of the hour to lower the burden of antibiotic resistance. The present study was designed to assess the knowledge, attitude, and practices toward antibiotic usage and resistance among medical students and interns.Materials and Methods: A cross-sectional questionnaire-based study was conducted at a tertiary care teaching hospital involving 5th, 7th, and 9th term medical students and interns. A pre-tested questionnaire with 22 knowledge and 13 attitude items was assessed by 3-point Likert scale and 9 practice items by yes/no. For knowledge items, each correct response represented with 1 mark. Grading of the knowledge was done as poor (≤50%), adequate (51–75%), and good (≥75%).Statistical Analysis: Frequency and proportions were usedResults:The response rate was 98.39% (367/373). Majority of the participants had adequate (46.6%) to good (45.5%) knowledge. Majority perceived that educating patients (94.8%) and taking responsibility of judicious use of antibiotics by everyone (92.6%) will reduce the burden of antibiotic resistance. However, 58% of the students were of the opinion that skipping one or two doses will not lead to antibiotic resistance and 68.4% of the participants felt that irrational use of antibiotic practices done at local level will not matter for the development of resistance globally. More than 90% of the students executed good practice toward antibiotic usage.Discussion and Conclusion: In spite of adequate to good knowledge, there were attitudinal lacunae toward antibiotic usage and resistance. Interestingly, regardless of casual attitudes, the self-reported practices of the participants were found to be substantially good. There is a need for strategizing educational programs for students and interns not only to enhance the knowledge but also to reshape the behavior of the students.
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Diabetic peripheral neuropathy (DPN) is a well-known microvascular complication of type 2 diabetes mellitus (T2DM). DPN is defined as peripheral nerve dysfunction in diabetics after exclusion of other causes. To assess the prevalence of peripheral neuropathy in T2DM and the associated risk factors among in outpatients department in a south Indian hospital. A cross-sectional observational study was conducted on 868 subjects (509 with DPN and 359 without DPN). Prevalence of diabetic peripheral neuropathy was measured and risk factors for the development of diabetic peripheral neuropathy were determined by calculating odds ratios and drug utilization pattern was assessed. The prevalence of DPN in T2DM was significantly higher in the subjects who are married, uneducated, housewives, and urban residents. Many associated risk factors could affect T2DM leading to DPN such as hypertension, other diseases, endocrine diseases, history of cardiovascular diseases (CVD), >9 HbA1c, low high-density lipoproteins (HDL), high serum creatinine, long duration of diabetes, physical inactivity, and habit of taking junk foods (weekly once and weekly twice, soft drinks occasionally). The present study revealed that risk factors for the development of DPN were hypertension, endocrine diseases, history of CVD, poor glycemic control (>9 HbA1c), low HDL, high serum creatinine, long duration of diabetes, physical inactivity, habit of taking junk foods and soft drinks. Early detection of the identification of DPN in T2DM is needed in order to slow progression and complications. Metformin (40.47%), combination of glimepiride and metformin (29.93%), combination of human insulin and insulin isophane (22.7%) were mostly given to the T2DM patients with neuropathy
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Background: Organophosphate (OP) poisoning is one of the most common pesticide poisoning in India in adolescents because of its easy availability. Serum pseudocholinesterase levels are commonly used to assess the severity and to know the prognosis in OP compound poisoning. Serum creatine phosphokinase (CPK) levels is another lab parameter which gets deranged in OP poisoning and has been tried in adults to assess the severity and to know the prognosis.'Authors objective was to study the correlation of serum pseudocholinesterase and serum CPK in organophosphate poisoning at admission and to compare outcome with serum CPK levels.Methods: All the children in the age group of 1 month to 18 yrs, who were admitted with the history of suspected OP compound poisoning were enrolled for the study. Estimation of cholinesterase and CPK levels were done at admission and after 1 week. Patients were categorised in to latent, mild, moderate and severe cases based on the S. Cholinesterase levels. These values were analysed to see the correlation.Results: Among 34 OP poisoning cases,13(38%) were males and 21(62%) were females. Mean age of study population was12.6+4.25 yrs. The median CPK values in latent, mild, moderate and severe cases were 121.5 IU/L,276.5 IU/L, 308IU/L and 467IU/L respectively (p=0.015). Spearman's rho Correlation coefficient was -0.522 between S. Cholinesterase and S CPK at admission which was significant. The median serum CPK level after 1week in non survivors was 2498.0IU/L and in survivors was 201.0IU/L (p0.014).Conclusions: There was a strong negative relationship between serum cholinesterase and serum CPK at admission in OP poisoning. Follow up values at 1 week showed that significantly high serum CPK and low cholinesterase, which was also significant and was associated with mortality.
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Background: Topical steroid is most commonly prescribed in non-infective dermatological conditions. Periodical Prescription audit is mandatory for the effective management. Hence the present study is designed to assess the prescribing pattern and cost analysis of topical steroids for various skin disorders in the dermatology OPD of a teaching hospital.Methods: This is a prospective observational study conducted in dermatology OPD of a teaching hospital from Jan-Mar 2019 in patients prescribed with topical steroids in all age groups after obtaining IEC approval. Data was analyzed for prescription pattern and cost analysis using descriptive statistics and expressed in percentage.Results: A total of 90 prescriptions were analyzed among which males were 45% and females were 55%, the common indications were eczema-27.7%, atopic dermatitis-25.5%, psoriasis-16.6%, dermatoses-13.3%, lichen planus-7.77% etc. Topical steroids commonly prescribed were super potent (Clobetasol 34.4% and Halobetasol 22.2%). Cream and ointment formulation were commonly used. Common adverse reactions were skin atrophy, hypopigmentation, acne. In prescribing pattern, specification of strength and quantity were lacking whereas instructions regarding area of application-44.4%, route of administration-83.3%, frequency and duration-91% were noted. In cost analysis, comparison is made between similar potency and clinical outcome. Of which, Clobetasol 0.05% and Betamethasone 0.01% is found to be cost effective compared to Halobetasol 0.05% and Mometasone 0.1% respectively.Conclusions: This study provides a limelight on prescribing pattern of topical steroids and emphasize periodic audit to rationalize the prescription with cost effectiveness.
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Leprosy an ancient curable chronic infectious granulomatous disease. In the absence of the classic involvement of the peripheral nerves, the clinical manifestations of leprosy are diverse and can mimic a host of other skin disorders. The clinical classification of early lesions of leprosy is often difficult, where skin biopsy plays a crucial role in diagnosis.
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Background: Human papilloma virus infection is responsible for 75-80% of the cervical cancers worldwide. Human papilloma virus infection is a preventable disease, but precaution depends on the cognitive aspects of young women. Authors conducted a study to assess the knowledge, attitude and practices regarding human papilloma virus vaccination and to determine acceptance rate of human papilloma virus vaccination among medical and paramedical students.Methods: Human papilloma virus infection is responsible for 75-80% of the cervical cancers worldwide. Human papilloma virus infection is a preventable disease, but precaution depends on the cognitive aspects of young women. Authors conducted a study to assess the knowledge, attitude and practices regarding human papilloma virus vaccination and to determine acceptance rate of human papilloma virus vaccination among medical and paramedical students.Results: Out of 322 students, 114 medicals (35.4%), 106 pharmacy (32.9%) and 102 nursing students (31.7%) were included in this study. Ninety-one (79.8%) medical students, 64 (60.37%) pharmacy students, 43 (42.1%) nursing students were aware that human papilloma virus can cause cervical cancer. Seventy-three (64.03%) medical students, 64(60.37%) pharmacy students, 40(40.1%) nursing students were aware that there is vaccination for human papilloma virus infection, and it can prevent cervical cancer. Most of the students,78(68.4%) medical students, 57 (53.77%) pharmacy students and 46(45.09%) nursing students believe that more awareness required regarding risk factors of human papilloma virus infection and prevention of cervical cancer. Furthermore, around 66 (57.89%) medical students, 44 (41.05%) pharmacy students, 37(36.27%) nursing students were willing to accept the vaccine for themselves.Conclusions: Majority of the students are lacking knowledge regarding HPV vaccination and cervical cancer prevention with least knowledge among paramedical students. More awareness programmes are required to increase the awareness and acceptability of HPV vaccination.
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Introduction: Anterior cerebral artery (ACA), the smaller terminal branch of the internal carotid artery is significantclinically due to its wide variety of complexity and technical difficulty in surgical procedures.Methods and materials: This study was done in 50 embalmed adult brain hemispheres at Institute of Anatomy,Madras Medical College, Tamilnadu. The study of the anterior cerebral artery was undertaken to observe themode of origin, its course and branches.Results: Anterior cerebral artery originated from the internal carotid artery in 100% of specimens. ACA passedabove optic nerve in 32 specimens (64%), above optic chiasma in 16 specimens (32%) and above optic tract in 2specimens (4%). The average length of A1 segment of right ACA and left ACA were 14.3 mm and 13.7 mm respectively.The difference in diameter of 1mm or more on both sides was observed in 8%. Left A1 segment was duplicated in1 specimen (2%). Median artery of corpus callosum and Azygous anterior cerebral artery were found in onespecimen each. Fenestration of A2 segment was observed in one specimen (4%). Heubner’s artery arose from A2segment in 32 (64%) specimens, from A1 segment in 6 (12%) specimens and from the level of ACoA in 12 (24%)specimens. The orbitofrontal artery originated on an average distance of 5.73mm on right side and average of4.82mm on left side. Frontopolar artery(FPA) originated at a distance of about 20.2mm on right side and 17.6mmon left side. Callosomarginal artery and pericallosal artery were found in all the specimens. In one specimen theright FPA originated from callosomarginal artery.Conclusion: Rapidly advancing fields of vascular neurosurgery and interventional neuroradiology techniquesrequire a thorough understanding of the anatomy. This detailed study done under various parameters wouldbenefit the radiologists and neurosurgeons.
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Background: Kerosene poisoning, a commonly encountered situation in pediatric emergencies, caused varied systemic manifestations ranging from asymptomatic state to altered sensorium and cardiac arrhythmias. Gupta score has been traditionally used to prognosticate such cases. Limited number of studies have been done previously despite high incidence rates pertaining to laboratory and radiological features. Present study aimed to determine association between these features and outcome in terms of duration of stay.Methods: A retrospective study consisted of all children presented with kerosene poisoning from May 2017 to May 2018. CBC was done within 12 hours of presentation and CXR was taken after 6 hours of exposure. These values were compared against duration of stay to predict prognosis.Results: Most children were in age group of 1-3 years, male predominance 62.9%. Quantity of consumption didn't have any effect on outcome. Large proportion of children were asymptomatic 60%, followed by hurried breathing 31.5% - most frequent presenting complaint. Peak duration of consumption was 4 pm to 8 pm. CBC parameters- Hemoglobin status and WBC counts failed to have correlation with outcome in terms of duration of stay. CXR taken after 6 hours exposure- was imperative to predict outcome.Conclusions: Radiological features on CXR in addition to clinical symptoms could be used to decide likely outcome after kerosene consumption.
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Background: In India, 54% of under five children death mainly due to under nutrition. First two years of age is most critical. Nutritional status was assessed by using WHO standard growth chart. Wasting represents acute malnutrition, stunting with chronic, underweight represents both acute and chronic. Based on NFHS-3 data the prevalence of under nutrition rise up to 2 years of age, thereafter more or less stabilizes. Faulty feeding practices plays major role in under nutrition. Hence, this study carried out to assess nutritional status of 6 months to 2 years children in terms of acute and chronic malnutrition and to estimate the association of nutritional status with feeding practices.Methods: Cross sectional study done during March to August 2016. Sample size estimated was 180. Stratified random sampling method used to collect data among children in Peerkankaranai.Results: Mean age of children was 15.82 months. About 61.2% belonged to 12 to 24 months age group. Sex distributions were equal. About 55% belongs to middle socioeconomic status. The prevalence of underweight was 31.65, wasting 15%, stunting 45.6%. Male children affected by chronic malnutrition more than female children. Not initiating breast feeding within 4 hours of birth plays significant role in acute malnutrition. Prevalence of malnutrition was high among those not practising colostrum feeding and exclusive breast feeding. Only 15 mothers not influenced by formula feeding. Feeding frequency and traditional feeding practices had main role in chronic malnutrition.Conclusions: The prevalence of under nutrition among study population was high among this area. Feeding practices should be improved among the mothers.
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Background: Verrucae are benign tumors involving skin and mucous membrane that are caused by human papillomavirus (HPV). Several treatment modalities are available for treating extensive warts, but no single treatment is 100% effective. An ideal treatment should be effective, safe, with less morbidity and provide long-lasting immunity against HPV. This can only be achieved by stimulation of the immune system against the virus. The auto-implantation of warts is one such simple technique where the wart tissue is harvested as a donor and implanted into the uninvolved skin, thereby causing immune stimulation against the virus and resulting in the resolution of extensive and recalcitrant verrucae. Aim: The aim of the study was to evaluate the safety and efficacy of auto-implantation therapy in the treatment of extensiveand recalcitrant verruca vulgaris. Materials and methods: A hospital-based prospective interventional study was carried out on 50 clinically diagnosed patients of extensive verruca vulgaris. Homologous auto-implantation was done over the uninvolved flexor aspect of the forearm skin after harvesting wart tissue up to the level of the papillary dermis. Patients were assessed monthly and resolution after 3 months was considered as complete clearance. Results were analyzed using SPSS version 20.0. Results: Out of 50 patients, 41 patients came for regular follow up whereas 9 patients didn’t turn up for the follow-up. Out of 41 verrucavulgaris patients, 34 showed resolution within 3 months, accounting for a total clearance rate of 82.9%.
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Introduction: The Pathologist’s familiarity of the vast collection of benign mimickers is important in the systematic approach to the diagnosis of prostatic adenocarcinoma. Awareness of these patterns on light microscopy coupled will guide to a correct diagnosis and avoid a false-positive and false negative cancer interpretation. Aims; To study the histopathological features of mimics of prostatic adenocarcinoma, to differentiate histopathologically between mimics and adenocarcinoma. Methods: This study is done in institute of pathology, madras medical college, Chennai during the period of July 2012 to June 2014. The H&E slides from prostatic samples are viewed and various benign and premalignant mimickers are identified. Results: Out of 492 cases analysed 134 mimickers were identified. Benign mimickers are commonly found (79%) than premalignant mimickers (21%).Among benign lesions basal cell hyperplasia is the commonest followed by atrophy. Conclusion: Premalignant lesions are commonly seen in association with adenocarcinoma.
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Background: Gastric carcinomas have various pathological features. Based on patterns of growth and invasiveness, however, they fall into two types: diffuse type and intestinal type. These two types of carcinoma appear to be different in their histogenetic origins. Objectives: To analyse various types of gastric cancer reported in last five years. To compare the features of intestinal and diffuse type gastric carcinoma including gross appearance, staging, grading of tumor. Materials and Methods: This was a retrospective study of 324 gastric cancer which were surgically resected and received over 5 years. The tumors were divided into groups according to their gross and microscopic patterns. Gross appearance was classified based on Borrmann classification. Microscopic features evaluated include tumor cell type, extent of invasion, degree of maturation, formation of glandular structures, nodal metastasis. Results: Totally 320 cases of gastric cancer were received of which 218(68%) were male, 102(32%) were female. Gastric cancers are rare below the age of 30 years. Comparing the type of gastric cancer intestinal type were 269(84%), diffuse type were 24(7.5%) and other type of gastric cancer including GIST, lymphoma, mucinous adenocarcinoma were 27(8.5%). Younger patients have higher stage of lymph node metastasis in diffuse type, but not for the intestinal type. Conclusion: Gastric cancer more common in male (M:F= 2:1) and most frequently seen in 5th decade. Intestinal type constitutes the most common type of gastric tumor. Gross appearance of diffuse type was predominantly infiltrative (79%).
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ABSTRACT Key words: In recent years, applications of Bessel functions have been effectively used in the modelling of chemical engineering processes and theory of univalent functions.In this paper, we study a new class of analytic and univalent functions with negative coefficients in the open unit disk defined by Modified Hadamard product with Bessel function. We obtain coefficient bounds and exterior points for this new class.