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OBJECTIVE@#To develop a qNMR method for quantitative analysis of triacylglycerols in fruit oil of Hippophae rhamnoides (seabuckthorn, SBT) and analyze commercial samples of SBT oils using GC-MS and FTIR.@*METHODS@#SBT fruit oil (IPHRFH) was extracted with hexane and the triglyceride (TAG) was isolated by vacuum liquid chromatography. Six different branded SBT oils purchased from e-commerce suppliers (Amazon) and in-house prepared SBT oil was analyzed by qNMR and fatty acyl composition of TAGs determined by using NMR. In-house oil was also analysed by GC-MS and FTIR spectroscopy.@*RESULTS@#The qNMR results showed that the oil contained 80.3% of triacylglycerol (TAG). The SBT oil TAGs comprised of linolenate 6.6%, palmitoleate/oleate 65.4%, and total saturated fatty acyl chain including palmitate 28% as determined by qNMR. GC-MS analysis revealed that the major acyl functionalities present in the TAG were palmitoleic acid 36.5%, oleic acid 12.9%, palmitic acid 21.2%, and linoleic acid 18%. Of the six commercial samples analyzed, samples from only one supplier (SW) were fruit oil; All others were the seed oils or mix of fruit oil and seed oil. The labels for samples except for the SW did not indicate whether it was fruit oil or seed oil.@*CONCLUSION@#The results suggest that SBT oil should be analyzed by combination of GC-MS, FTIR and qNMR for factual content of free fatty acid or TAGs, which are chemically different in nature and affect the quality of oil. GC-MS showed the content of omega free fatty acids after hydrolysis, while qNMR and FTIR showed the content of TAGs. The major acyl functionalities found in SBT fruit oil TAGs are palmitoleate/palmitate/oleate, while linoleate and linonelate make up a minor fraction. Furthermore, analysis of commercial samples showed discrepancies between label claims and actual content.
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Background & objectives: The high mortality associated with the thrombotic events in hospitalized COVID-19 patients resulted in the usage of anticoagulants in varying doses. Whether high-dose anticoagulants have led to better outcomes or higher incidence of clinically significant bleeding events is debatable. Thus, this study was conducted to find the incidence of clinically significant bleeding events in moderate-to-severe COVID-19 ARDS (acute respiratory distress syndrome) patients on therapeutic anticoagulation and their outcomes. Methods: In this retrospective, single-centre study of 155 critically ill COVID-19 patients, the incidence of clinically significant bleeding was observed. Multivariate regression models were used to evaluate the association between anticoagulant regimen, coagulation and inflammatory markers with the incidence of bleeding and thrombotic events. Results: The incidence of clinically relevant non-major bleeding was 33.54 per cent (26.17-41.46%) and major bleeding was 9.03 per cent (5.02-14.69%). The anticoagulation intensity at baseline had a high odds of major bleeding when enoxaparin and dual antiplatelet therapy were used together [adjusted odds ratio OR of 434.09 (3.81-49502.95), P<0.05]. At admission, bleeders had a poorer PaO2/FiO2 ratio with more patients on invasive ventilation. At the time of bleeding, the bleeders had a higher D-dimer, ferritin, C-reactive protein and procalcitonin compared to non-bleeders. The subhazard ratio for death in bleeders was 3.35 (95% confidence interval, 1.97-5.65; P<0.001). Interpretation & conclusions: The incidence of bleeding in critically ill COVID-19 patients on therapeutic anticoagulation may increase with the severity of the disease as well as with concurrent use of dual antiplatelets. Major bleeding may also contribute to higher mortality.
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Congenital complete heart block (CCHB) has an incidence of one in 20,000 live births and carries a 20% risk of mortality. The hemodynamic instability due to bradycardia and asystole due to the increasing metabolic demands can be avoided by appropriate antenatal planning, timely delivery and initiation of medical treatment and early pacemaker insertion. In this report, we discuss the anaesthetic challenges of permanent epicardial pacemaker insertion with good outcomes in a 32?week gestational age 1380 grams neonate within a few hours of birth.
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Due to changing priorities of medical students in the present day scenario, an insight of their Emotional Intelligence (EI) can serve as a predictor of their compassionate and understanding domain. The relation of EI with academic performance will give an idea on how the emotional or indirectly psychological component plays a role in the manner the medical students perform. Importance of Emotional Intelligence (EI) is increasingly recognised. It is more relevant in medical professionals who have an inbuilt touch of emotions to the profession. The study was conducted to evaluate EI of 7th semester MBBS students and also to determine the relation if any of EI with their academic performances. METHODSThis descriptive cross sectional study was conducted in a Government Medical College in Central India. The study was carried out among 159 medical students. Data collection was done with the aid of a structured, pretested questionnaire which had questions based on the Quick Emotional Intelligence self-administered questionnaire. Academic scores of previous MBBS years were considered. The relation between emotional intelligence and academic scores was studied. Data was entered in Microsoft excel. Statistical analysis was done with help of Open Epi Info. RESULTSMean ± Standard Deviation of Emotional awareness, Emotional Management, Social Emotional Awareness, and Relationship Management scores were 23.94 ± 4.86, 24.56 ± 6.49, 27.75 ± 5.77 and 25.91 ± 6.46 respectively. Mean total Emotional Intelligence score including all domains was 102.16 ± 18.38. A weak positive correlation was established between EI and academic scores. CONCLUSIONSEI of medical students was directly associated with their academic scores.
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Introduction: The diagnosis of acute appendicitis has essentially been clinical, but USG abdomen has been said to be highly accurate in diagnosing AA. The surgeon’s perspective may not always be the same. Materialsand methods: Appendectomy data of 106 patients from two hospitals of Kangra region was retrospectively analysed. The data was collected for age, sex, initial pre-operative diagnosis, USG findings, intra-operative findings, Histo-pathological examination (HPE) report, post operative hospital stay. Observations:It revealed a sensitivity of about 54% and specificity of 100% for diagnosing AA with the help of USG abdomen. AA was seen most commonly in males as compared to females. Mean age of presentation was 29.34 +/-14.4 years. Mean hospital stay was 3.68 +/-2.25 days. Most common initial preoperative diagnosis was AA (84%). Most common position of the appendix during surgery was retrocecal (53.7%). HPE report revealed AA in 105 patients. Conclusion:USG abdomen is often falsely assuring, leading to unnecessary delay in effectively managing a patient of AA further leading to increased complications. Only the clinically equivocal cases require further radiological investigations where CECT abdomen is the preferred investigation, but it should be used judiciously.
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ustification: A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However,these guidelines are for patients living in high income countries. Separate guidelines, applicable to Indian children, are required whenrecommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and mayhave co-existing morbidities and malnutrition. Process: Guidelines emerged following expert deliberations at the National ConsensusMeeting on Management of Congenital Heart Diseases in India, held on 10th and 11th of August 2018 at the All India Institute of MedicalSciences, New Delhi. The meeting was supported by Children’s HeartLink, a non-governmental organization based in Minnesota, USA.Objectives: To frame evidence based guidelines for (i) indications and optimal timing of intervention in common congenital heartdiseases; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases.Recommendations: Evidence based recommendations are provided for indications and timing of intervention in common congenitalheart diseases, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductusarteriosus and others), obstructive lesions (pulmonary stenosis, aortic stenosis and coarctation of aorta) and cyanotic congenital heartdiseases (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebsteinanomaly and others). In addition, protocols for follow-up of post surgical patients are also described, disease wise.
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Introduction A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However, these guidelines are for patients living in high-income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and may have co-existing morbidities and malnutrition. Process Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on the 10th and 11th of August, 2018 at the All India Institute of Medical Sciences. Objectives The aim of the study was to frame evidence-based guidelines for (i) indications and optimal timing of intervention in common congenital heart diseases and (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases. Recommendations Evidence-based recommendations are provided for indications and timing of intervention in common congenital heart diseases, including left-to-right shunts, obstructive lesions, and cyanotic congenital heart diseases. In addition, protocols for follow-up of postsurgical patients are also described.
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PURPOSE@#Reduction and fixation in femoral neck fracture in young patients have a problem of nonunion requiring additional procedure like valgus osteotomy but fixation devices are technically difficult for inexperienced surgeons. We aims to assess the results of valgus osteotomy in femoral neck fracture in our setup.@*METHODS@#We report a series of 20 patients of higher Pauwel's angled fracture of femoral neck fracture presenting late wherein for valgus osteotomy was added to reduction fixation secured with a commonly available 135° dynamic hip screw and plate.@*RESULTS@#Femoral neck fractures united in 16 patients (80%). Excellent to good results (Harris hip score >80) were seen in 70% patients. Angle of correction of preoperative Pauwels has been changed from 68.3 to 34.3.@*CONCLUSION@#135° dynamic hip screw and plate provides rigid internal fixation after valgus osteotomy and being a more familiar fixation device simplifies the procedure with good results.
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Adult , Female , Humans , Male , Middle Aged , Bone Plates , Bone Screws , Femoral Neck Fractures , General Surgery , Femur Neck , General Surgery , Follow-Up Studies , Fracture Fixation, Internal , Methods , Osteotomy , Methods , Pelvic Bones , General SurgeryABSTRACT
Vermiform appendix should not be considered a vestigial organ in human beings but a lymphoid organ which when inflamed causes serious trouble. Acute appendicitis usually presents with pain and tenderness in the right iliac fossa associated with nausea and anorexia. It may have an atypical presentation depending on the position of the appendix. In post-ileal appendicitis, the pain is localized around the umbilicus and the shifting of pain may be absent. The ultrasound of abdomen may not be very helpful in this case, but the computed tomography scan of the abdomen may help reach the diagnosis. The delay in diagnosis and subsequent treatment of acute appendicitis may have catastrophic results.
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To evaluate and compare the efficacy of orally administered midazolam, clonidine and dexmedetomidine with regard to preoperative sedation, effect on parental separation, acceptance of face mask and recovery profile in children. This was a prospective, randomized, double blind clinical trial, conducted in a tertiary care hospital, in which 80 children in the age group of 1-4 years were included. The study population was divided into three groups and each group was premedicated with one of the three oral premedicants. Patients in Group-M received 0.5 microg/kg of oral midazolam 30 min before the surgery, Group-C received 4 microg/kg of oral clonidine 90 min before the surgery and Group-D received 4 microg/kg of oral dexmedetomidine 60 min before the surgery mixed in honey. In the waiting area sedation score, parental separation score, mask acceptance at induction were measured on 4 point scales. In the PACU, children were monitored for NIBP, EGG, SpO2 and Steward Recovery Score every 15 min for 2 hours. Nausea, vomiting, shivering or other complications if any and time taken to achieve Steward Score of 6 was noted. The statistical analysis was carried out using Statistical Package for Social Sciences [SPSS Inc., Chicago, IL, version 15.0 for Windows]. All the three groups had comparable sedation. Parental separation was easy for children in Group-M [96.6%] and Group-D [93.6%] while it was significantly low in Group-C [63-5%][p=0.001]. Significantly higher number [96.6%] of children in Group-M showed satisfactory mask acceptance in comparison to Group-C [45.8%] and Group-D [25.9%][p<0.001]. Recovery from anaesthesia was significantly faster in Group-M when compared with Group-C and Group-D [p<0.001]. Despite effective preoperative sedation [>90%] with the two alpha-2-agonists, clonidine and dexmedetomidine, parental separation and mask induction was not satisfactory as compared to midazolam
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STUDY DESIGN: Prospective clinical study. PURPOSE: The present prospective study aims to evaluate the clinical, radiological, and functional and quality of life outcomes in patients with fresh thoracolumbar fractures managed by posterior instrumentation of the spine, using pedicle screw fixation and monosegmental fusion. OVERVIEW OF LITERATURE: The goals of treatment in thoracolumbar fractures are restoring vertebral column stability and obtaining spinal canal decompression, leading to early mobilization of the patient. METHODS: Sixty-six patients (46 males and 20 females) of thoracolumbar fractures with neurological deficit were stabilized with pedicle screw fixation and monosegmental fusion. Clinical, radiological and functional outcomes were evaluated. RESULTS: The mean preoperative values of Sagittal index, and compression percentage of the height of the fractured vertebra were 22.75degrees and 46.73, respectively, improved (statistically significant) to 12.39degrees, and 24.91, postoperatively. The loss of correction of these values at one year follow-up was not statistically significant. The mean preoperative canal compromise (%) improved from 65.22+/-17.61 to 10.06+/-5.31 at one year follow-up. There was a mean improvement in the grade of 1.03 in neurological status from the preoperative to final follow-up at one year. Average Denis work scale index was 4.1. Average Denis pain scale index was 2.5. Average WHOQOL-BREF showed reduced quality of life in these patients. Patients of early surgery group (operated within 7 days of injury) had a greater mean improvement of neurological grade, radiological and functional outcomes than those in the late surgery group, but it was not statistically significant. CONCLUSIONS: Posterior surgical instrumentation using pedicle screws with posterolateral fusion is safe, reliable and effective method in the management of fresh thoracolumbar fractures. Fusion helps to decrease the postoperative correction loss of radiological parameters. There is no correlation between radiographic corrections achieved for deformities and functional outcome and quality of life post spinal cord injury.
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Humans , Male , Congenital Abnormalities , Decompression , Early Ambulation , Follow-Up Studies , Prospective Studies , Quality of Life , Spinal Canal , Spinal Cord Injuries , Spine , Surgical InstrumentsABSTRACT
AlM: To study the pattern/distribution of retinal vascular diseases in the hilly terrain of Himachal Pradesh (altitude ranging from 500-4500m above sea level). METHODS: lt is a retro/prospective study of patients with retinal diseases attending the general ophthalmology clinic of a tertiary care facility at Shimla from August 2008 to April 2013. Out of 5600 subjects, 4323 were taken as a sample. The data were taken from the hospital records and thereafter analyzed to determine their age, sex distribution and diagnosis. All patients underwent visual acuity, refraction, slit lamp examination and fundus evaluation. The diagnosis was confirmed from fundus clinic records and evaluation of fundus photographic records retro/prospectively. The photographs were taken on the fundus camera (Kowa Fundus Camera VX-10) and fundus fluorescein angiography done where ever indicated. RESULTS:Out of the 4323 patients, there were more males 2563 ( 59. 29%) than females 1760 ( 40. 71%) with retinal diseases. Out of the 525 ( 12. 14%) diabetic retinopathy ( DR) subjects, mild non-proliferative diabetic retinopathy was present in 133 (3. 08%), moderate non-proliferative diabetic retinopathy in 156 (3. 60%), severe non-proliferative diabetic retinopathy in 120 (2. 78%) and proliferative diabetic retinopathy in 116 (2. 68%) subjects. Amongst the 393 (9. 10%) subjects of hypertensive retinopathy, hypertensive retinopathy-grade 1 ( was present in 130 ( 3. 01%) , hypertensive retinopathy - grade 2 in 111 (2. 57%), hypertensive retinopathy-grade 3 in 131 (3. 03%) and hypertensive retinopathy - grade 4 in 21 ( 0. 49%) subjects. Of all the 660 (15. 27%) subjects of other retinal vascular disorders, branch retinal vein occlusion ( BRVO) was present in 229 (5. 30%), central retinal vein occlusion (CRVO) in 55 (1. 27%), hemi central vein occlusion in 8 (0. 19%), central retinal artery occlusion ( CRAO) in 20 (0. 46%), branch retinal artery occlusion in 4 (0. 09%), ocular ischaemic syndrome in 1 (0. 02%), retinopathy of prematurity in 9 (0. 21%), retinal artery macroaneurysm in 5 (0. 12%), juxtafoveal telangiectasia in 6 (0. 14%), anaemic retinopathy in 16 (0. 37%), leukemic retinopathy in 10 (0. 23%), preretinal haemorrhage in 52 (1. 20%), Coats disease in 8 (0. 19%), cilioretinal artery occlusion in 1 (0. 02%), Eales disease in 10 (0. 23%), vasculitis in 17 (0. 39%) and clinically significant macular edema in 209 (4. 83%) subjects. CONCLUSlON: DR was the most common retinal vascular disorder. Retinal disorders appear to be a major public health problem in lndia. The present study shall help us in planning the management of such disorders in the hilly state of Himachal Pradesh to reduce the visual morbidity arising out of such disorders.
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Nitrobenzene is a synthetic organic compound, pale yellow in colour, freely soluble in alcohol, with a pleasant odour like that of bitter almonds or shoe polish. It is widely used in chemical industry, and is present in commercial products such as shoe and metal polish, ink, paint remover and soap. Poisoning due to nitrobenzene is usually chronic in nature, mainly due to occupational exposure, except for a few acute cases of industrial accidents or suicides. We report three cases of fatal nitrobenzene poisoning through oral ingestion. All persons consumed alcohol prior to, or along with nitrobenzene. The alleged manner of poisoning was different in every case (one case each of homicide, suicide and accident). Clinical features, autopsy findings and medicolegal aspects of nitrobenzene poisoning are discussed.
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A 42 year old male, was found hanging by a plastic rope in his unbolted bed room. The rope was found attached to two suspension points (one end attached to the window panel and the other side to the ceiling knob) and the middle part of it used for the binding of neck. There was no knot present in the ligature as the right hand was found holding the ligature loop for the purpose of constriction of neck .A towel was found covering the head and underneath the ligature material on the neck used for padding. Blood stain was present on the floor below the suspended body which oozed out from the haemorrhoids. He was holding the cloth, wore in lower half of the body up to the mid thigh label, which appreciated by the authors as cadaveric spasm that developed in his flexor muscles of left hand. Detailed autopsy, crime scene examination and police investigation supported the manner of death as suicidal.
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Adult , Asphyxia/mortality , Asphyxia/pathology , Autopsy , Cadaver , Cause of Death , Fatal Outcome , Forensic Pathology , Humans , Ligation/epidemiology , Ligation/mortality , Male , Neck Injuries/pathology , Postmortem Changes , SpasmABSTRACT
Pseudoaneurysm is a rare condition arising from disruption in arterial wall with blood dissecting into the tissues around the damaged artery creating a perfused sac that communicates with the arterial lumen. Its incidence is on rise due to increase in endovascular procedures, hemodialysis and intravenous drug abuse. Here we report an young male who was found by a NGO worker, lying on roadside near a Mandir with a pulsatile inguinal swelling and blood oozing out from it. He was taken immediately to emergency department of LN Hospital. He was a rickshaw puller and known drug addict. The swelling was diagnosed as pseudo-aneurysm of common femoral artery on clinical examination and by Doppler ultrasonogrphy. He was referred to CTVS department and admitted there for surgery. In the meanwhile, he collapsed in the hospital toilet and died due to hemorrhagic shock consequent upon rupture of pseudoaneurysm of femoral artery. In this report the gross and histopathological findings of pseudo-aneurysm of common femoral artery were described in autopsy.