Management of Bronchomalacia in Infants Post?Cardiac Surgery Using Synchronized Nasal DuoPAP: A Novel Technology

Background:Tracheo?bronchomalacia (TBM) is the weakness in the structural integrity of the cartilaginous ring and arch. It may occur in isolation with prematurity or secondarily in association with various congenital anomalies. Bronchomalacia is more commonly associated with congenital heart diseases. The conventional treatment options include positive pressure ventilation with or without tracheostomy, surgical correction of external compression and airway stenting. Aim: To use “synchronized” nasal Dual positive airway pressure (DuoPAP), a non?invasive mode of ventilation as an alternative treatment option for bronchomalacia to avoid complications associated with conventional treatment modalities. Study Design: Prospective observational study conducted in Army Hospital Research and Referral from Jul 2019 to Dec 2020. Material and Methods: We diagnosed seven cases of TBM post?cardiac surgery at our institute, incidence of 4.2%. Four infants were diagnosed with left sided bronchomalacia, 2 were diagnosed with right sided bronchomalacia and one with tracheomalacia. Those infants were managed by “synchronized” nasal DuoPAP, a first in ventilation technology by Fabian Therapy Evolution ventilator (Acutronic, Switzerland). Results: All seven infants showed significant improvement with synchronized nasal DuoPAP both clinically as well as radiologically. None of the infant required tracheostomy and discharged to home successfully. Conclusion: The synchronized nasal DuoPAP is a low cost and effective treatment option for infants with TBM. It could be attributed to synchronization of the breaths leading to better tolerance and compliance in paediatric age group

Clinical profile and etiological spectrum of acute symptomatic seizures in the elderly populace

Aim: The current study aimed to analyze the etiology and the clinical spectrum of acute symptomatic seizures (ASS) and the predictors of in-hospital mortality in the elderly population. Materials and Methods: We evaluated 94 elderly (?60 years of age) hospitalized patients with ASS for clinical profile, etiologies, and predictors of in?hospital mortality. Results: Mean age of onset of ASS was 67.63 ± 11.48 years. The main seizure type was focal seizure in 62 (59.7%) cases, followed by tonic?clonic seizures in 30 (31.9%) cases. The most common aetiologies in ASS were stroke in 61.7%, followed by infective cause in 30.9% of cases. In?hospital mortality in the ASS in the elderly was 21 (22.3%) in our series, and stroke was the most common cause of mortality. Conclusion: Stroke was the most common etiology of ASS in the elderly and was also related to mortality. It is necessary for us to analyze the causes of ASS in the elderly, to reduce in hospital mortality.

Comparison of the efficacy and safety of topical timolol and oral propranolol for the treatment of Superficial Infantile Haemangiomas

Background: Infantile haemangiomas (IHs) are the most common vascular tumours of infancy. In recenttime oral propranolol has achieved great success in treating IHs. To minimize the systemic side events caused by oral propranolol, topical timolol started to be applied in the treatment of IHs, especially for superficial lesions. Methods: We treated 50 children with superficial IHs using oral propranolol on 25 patients and, topical timolol on 25 patients and investigated the efficacy and safety of the two treatment patterns. Results: Both oral propranolol and topical timolol achieved a satisfactory therapeutic outcome, with an effective response rate of 96 and 95.4%, respectively. No significant differences in visual analogy scale (VAS) improvement between the two groups were observed. Systemic adverse events for patients treated with oral propranolol (3.9%) was significantly higher than that for patients treated with topical timolol. Clinical response was not associated with gender, duration of treatment, lesion location, lesion size, and gestational age but closely associated with age at treatment initiation, which indicated that younger age at treatment initiation predicted for a better regression rate. Conclusion: Topical timolol could be the first-line therapy for superficial IHs because of its good efficacy and improved safety profile.

Comparative Evaluaton of Root Fracture Resistance Using Different Root Canal Sealers

Background: Endodontically treated teeth are widely considered to be more susceptible to fracture than vital teeth. To reinforce the instrumented teeth against fracture; sealers are used in conjugation with a core filling material. Methods: The 120 prepared teeth were randomly divided into four experimental groups and two control group of 20 teeth each. One control group of 20 teeth where access opened and left unistrumented and unobturated. Group- I: Teeth obturated with gutta percha and epoxy resin based sealer. Group- II: Teeth obturated with polymer based core and methacrylate based Sealer. Group- III: Teeth obturated with gutta percha and calcium silicate based sealer. Group IV: Teeth obturated with gutta percha and zinc oxide eugenol based sealer. Group V: Teeth instrumented and obturated with gutta percha without use of sealer (Positive control). Group VI – Teeth with no instrumentation or obturation (Negative control). Results: The mean fracture resistance values (in N) are Group I i.e. Epoxy resin root canal sealer – 286.06 N, Group II i.e. Methacrylate resin root canal sealer - 328.77N, Group III i.e. Calcium silicate based root canal sealer - 265.05N, Group IV i.e. Zinc oxide eugenol based root canal sealer - 269.85N, Group V i.e. Positive control (Obturated without root canal sealer) - 258.91N, Group VI i.e. Negative control (No instrumentation and obturation) - 285.41N. Conclusion: Among the root canal sealers; resin based root canal sealers showed higher resistance to fracture than non adhesive sealers

Role of perioperative echocardiography in repair of incomplete shone complex: A case series

Multilevel obstruction of left-sided heart structures was originally characterized by Shone et al. The formulation of an appropriate operative strategy remains challenging and needs to be individualized for this complex subset of patients. Intraoperative transesophageal echocardiography (TEE) not only helps in delineating spatial anatomy but also reveals associated anomalies that help in decision-making regarding operative strategies for these patients. Here, we discuss five such cases of Shone's anomaly presenting at varied age group with different associated anomaly in which intraoperative TEE played a pivotal role in the management.

Inadequacy of near-infrared spectroscopy cerebral oximetry monitoring for detecting neurological complication

Near-infrared spectroscopy (NIRS) cerebral oximetry is an established and standard monitoring modality for surgery under extracorporeal circulation with circulatory arrest. It helps to reduce the neurological complication, but in many instances, it becomes not only technically challenging but also is difficult to interpret and take corrective action based on the NIRS values. In this case study, we aimed to present the inadequacy of cerebral oximetry for detecting neurological complication.

Association of Pre-Diabetes, Diabetes and BMI with family history: A Cross Sectional study in an urban area of Varanasi

Introduction: Diabetes is undoubtedly one of the most challenging health problems in the 21st century. According to The International Diabetes Federation estimation India will have risen in people living with diabetes up to 87.0 million by 2030 from 50.8 million (2010). According to the World Health Organization criteria, the prevalence of known diabetes was 5.6% and 2.7% among urban and rural areas, respectively in 2009. Family history of diabetes is not only a risk factor for the disease but is also positively associated with risk awareness and risk-reducing behaviours. It may provide a useful screening tool for detection and prevention of diabetes. Hence the study was conducted to assess the association between family history with diabetes and pre-diabetes in an urban area of Varanasi. Methodology: A Community based cross-sectional study was conducted during July 2012 to December 2012 among 706 respondents of 20-65 year age group in Sunderpur, Varanasi. Out of which 359 male and 347 females were interviewed by using pretested semi structured interview schedule. Consent was taken to all respondents. Pregnant women and known cases of diabetes respondents were excluded from this study. Fasting Capillary blood glucose level measured with the help of Glucometer. Result: In the present study prevalence of pre-diabetes was 11.8% and diabetes 7.2 %, 0.6% were known diabetic. Out of the total 700 respondents, familial risk was observed only in 10.4%. Out of which 6.7% respondents were having positive family history of one parent and 3.7% were of both parents and siblings. Positive family history was observed more among pre-diabetics 24.4% and diabetics 24% as compared to respondents with normal blood glucose level 15.4%. The association was found to be statistically significant. Significant difference was observed on diabetes, pre-diabetes with family history. Conclusion & Recommendations: Family history of diabetes mellitus was observed in 10.4% of total screened respondents. Out of which 6.7% were having either parent and 3.7% both parents and siblings. Family history of diabetes is indeed a powerful independent risk factor for the diabetes and pre-diabetes. Our efforts should now be directed toward translating this awareness for use in public health programs.

Classification Of Epilepsies And Epileptic Syndromes Using International League Against Epilepsy 2010: A Hospital Based Study From Rural Population Of North India.

Objectives: To determine the distribution of various epilepsies and epileptic syndromes in the people with epilepsy (PWE) in view of limited published data from rural population of India. Material and Methods: A cross sectional, hospital based study was conducted among 500 PWE. The diagnosis of epilepsy and epileptic syndromes was established under the guidelines of the International League Against Epilepsy 2010. Results: Among 500 PWE 340 (68 %) were male. Mean age was 27.19±17.5 years. Age ranged from 8 months to 93 years. Structural –metabolic (53.2 %) etiology was the most common underlying causes followed by electroclinical syndrome in 26.4 % and 6.4% had a distinctive constellation. Central nervous system (CNS) infections were noted in 16.2%, epilepsy with generalized tonic- clonic seizures in 15% and pre- /perinatal insults in 12.2 % of PWE. Conclusion: Overall the most frequent etiologies of epilepsy in present study were central nervous system (CNS) infections, epilepsy with generalized tonic- clonic seizures and pre-/perinatal insults. Genuine hard work must be done to prevent the occurrence of epilepsy with prevention and successful treatment of infections along with up gradation of the pre/ perinatal care

Traumatic transection of descending thoracic aorta: A rare cause of pulmonary vein obstruction

Pulmonary vein obstruction is rare condition characterized by challenging diagnosis and unfavorable prognosis at advanced stage. Computerized tomography, magnetic resonance imaging, and transesophageal echocardiography (TEE) are often essential to reach a final diagnosis. External compression of pulmonary vein resulting from the mass effect of pseudoaneurysm and perianeurysmal hematoma due to aortic transection is extremely rare. We describe a case of traumatic transection of descending thoracic aorta where TEE was instrumental in the diagnosis of left upper pulmonary vein obstruction and help in the modification of the surgical plan.

Effect of Women Empowerment on Reproductive Health Care Practices among Northern and Southern Regions of India

Introduction: It is believed that empowered women can contribute to the health, productivity and benefit of the whole family and community and improved prospects for the next generation. The empowerment of women is a fundamental prerequisite for their health. With better reproductive health practices, women can go safely through pregnancy, child birth and fertility regulations. Objective: The main objective of this study is to investigate whether women empowerment in two study groups i.e., Northern states and Southern states of India is linked with their reproductive health practices. Data and Methodology: The data from the 2015-16 National Family Health Survey (NFHS-4) was used in the study. Women who were currently married or living with a partner were included in the analysis. Logistic regression analyses were conducted to examine the association between the reproductive health outcomes with the domains of women empowerment and other socio-economic and demographic variables. Results: Women‘s participation in household decision making having slightly higher percentage for a visit to family/ relatives in northern region under study, whereas the decision making in own health care as well as major and small household purchases were found higher in southern region. It can be surprisingly seen that women who justified refusing sexual intercourse to husband were significantly less likely to be assisted by a skilled person in delivery if overall Indian data is concerned, but no effect has been seen in northern and southern regions after the adjustment with socio-economic and demographic characteristics. The women who didn‘t support wife beating were more likely to use modern method of contraception in northern region.

Prevalence of diseases and usual treatment places among the elderly: A preliminary study in eastern Uttar Pradesh

Background: The increasing number of the elderly persons and their health problems has greater implications on public health programs in developing countries. Estimates of health problems of the elderly are required from time to time to predict trends in disease burden and to further plan health care for them. Therefore, this study was conducted to determine the prevalent diseases and places for seeking treatment among the elderly in eastern Uttar Pradesh. Data & Methodology: A community-based cross-sectional study was carried out for the elderly people (60 years & above) and the information was collected in a pre-tested instrument. Using multistage stratified random sampling procedure, a total of 417 elderly respondents were participated in the study. Information was sought on the respondents' socio-demographic characteristics, living arrangements and self-reported diseases suffering by the elderly. Results: Maximum numbers of diseased cases were among females (38.06 %) than males (26.45 %). Breathing problem was found one of the major problems among each sex of the elderly. It was found that more than half of the elderly living alone were suffering from one or more diseases. Most of the elderly of lower and middle social status groups were more inclined towards the private health facilities. About one-third of male and female elderly covered more than 5 kms from their residence to seek their treatment. Conclusion: Breathing problem and joint problems were prevalent in both male and female elderly populations. Social status and age of the elderly play important role in seeking treatment from the private/government health care facilities.

Factors associated with nutritional status among mothers and children in India

Background: This study examined the relationships between child, maternal, health care utilization and household characteristics and nutritional status of both mother and child in India. Nutritional status is the best indicator of the global well-being of a society. In India 36 percent of children, under five years of age suffer from underweight due to acute under nutrition. Methods: This study analyzed secondary data from fourth round of National Family Health Survey. Bivariate and multivariate logistic regression analyses were preformed to estimate the effect of independent variables on dichotomous dependent variables. Results: Result shows that prevalence of stunting among male and female children was 39.14% and 37.52% respectively. Prevalence of underweight and stunting increases with the increase in child age group. Prevalence of underweight was more between both the rural and poorer mothers. The odds of stunting among female children was significantly lesser than their male counterparts (OR=0.93). Children belong to the older mother were less likely to be underweight (OR=0.81 and 0.70 for the mother in the age group 25-34 and 35-49 years respectively). Household characteristics show a significant result for the risk of underweight among women. Conclusion: Finding suggests that child sex and age influence the nutritional status significantly. Analysis indicate that increasing maternal age and educational attainment have statistical significant and positive effect on both maternal and child nutritional status. Study also found that utilization of health care services has better impact on nutritional status of both mother and child.

Evidence of Efficacy of Cemented Versus Uncemented Fixation with Respect to Functional Outcome; A Comparative Study

Background: Total hip arthroplasty is one of the most successful and cost-effective surgical procedures and remains the treatment of choice for long-term pain relief and restoration of function for patients with diseased or damaged hips. The traditional method of fixation of an implant to bone involved the use of cement. The question regarding the efficacy of cemented as compared with cementless fixation arthroplasty continues. Comparisons of the efficacy of cemented and cementless total hip arthroplasty have been indirect or retrospective in nature without evolution of these issues: is one better than the other. In this study we are comparing functional outcome in cemented versus uncemented primary total hip arthroplasty. Methods: This study was conducted in the department of orthopedic surgery, L.L.R.M. Medical College, Meerut. The study was prospective and retrospective and included the patients operated from February 2011 onwards in S.V.B.P. Hospital. Patient were selected as per Inclusion and Exclusion criteria. All the patients were thoroughly examined including all injuries, abnormalities, pathologies and secondary changes of musculoskeletal system. Based on this, provisional diagnosis was made for every patient. They were divided into 2 groups, one who were operated by cemented THA and the second who were operated by uncemented THA. Patients in whom both cemented and uncemented THA were feasible, final decision to select the treatment was done by alternative case method. Pre and post-operative care were same for both groups. Patients selected for THA were put to pre surgery exercises. Their Harris Hip Score and SF36 score were documented. Patients were operated as given in pro forma. He or she was put to weight bearing / non weight bearing according to per op fixation. Results: The study comprises of a total of 44 patients presenting to S.V.B.P. Hospital, Meerut from August 2011 to October 2013. The mean age of the patients taken up for our study was 45.14 years with the youngest patient being 19 years old and the oldest being 70 years old. There were total 34 male patients (77%) and 10 female patients (23%) in our study. In total 50 operated hips, 26 (52%) were on right side while 24 (48%) were on left side. There were 38 cases, in which unilateral hip (86%) was operated and 6 cases (14%) had both hips operated. 3 cemented cases were bilateral and 3 uncemented cases were bilateral. Of the total (50) hips operated, 23 (46%) were operated by cemented total hip arthroplasty and 27 (54%) were operated by uncemented total hip arthroplasty. Of the total patients (44) operated, 20 (45) patients were operated by cemented total hip arthroplasty and 24 (55%) were operated by uncemented total hip arthroplasty. In all the 23 hips operated by cemented technique 28 mm head was used. In the 27 hips operated by uncemented technique, 28mm head was used in 8 hips (30%) and 36 mm head was used in 19 (70%) hips. The minimum duration of follow up was 2 months and maximum duration of follow up was 2 years. Patients were evaluated in pre op period and at 2 month, 6 month, 1 year and 2 year. Both cemented and uncemented groups were divided accordingly into 5 sub-groups for Harris Hip Score and 5 sub-groups for SF-36 Score. A total of 10 groups were available for Harris Hip Score and 10 groups for SF-36 Score in which comparison was done. Pre op Harris hip scores in both cemented (mean score 28.56) and uncemented (mean score 33.30) groups are poor and difference between them were not significant (P value 0.3536) and Pre op physical component summary score in both cemented (mean score 21.594) and uncemented (mean score 22.052) groups are poor and difference between them were not significant (P value 0.5661). Mean Harris hip scores for pre op, post op 2months, 6 months, 1 year and 2 years were 28.56, 80.56, 85.30, 86.88 and 89.40 respectively. When comparison was done between pre op Harris hip scores and post op scores, difference was extremely significant with a P value of 0.0004 for pre op and post op 4 year pair and P value of 0.0001 for all other pairs. Mean Harris hip scores for pre op, post op 2month, 6 month, 1 year and 2 year were 33.30, 85.70, 91.38, 93.06 and 89.29 respectively. When comparison was done between pre op physical component summary scores of sf-36 and post op scores, difference was extremely significant with a P value of 0.0001 for all the pairs. Mean physical component summary scores of SF-36 for pre op, post op 2month, 6 month, 1 year and 2 year were 21.594, 34.662, 38.190, 40.706 and 41.410 respectively and when comparison was done between pre op physical component summary scores of SF-36 and post op scores, difference was extremely significant with a P value of 0.0001 for all the pairs. Mean physical component summary scores of sf-36 for pre op, post op 2month, 6 month, 1 year and 2 year were 22.052, 38.935, 42.410, 45.206 and 43.557 respectively. Conclusion: Functional outcome evaluation in our study suggested that uncemented total hip arthroplasty is better than cemented total hip arthroplasty when compared using Harris Hip Score and Physical Component Summary Score of SF-36

Vascular airway compression management in a case of aortic arch and descending thoracic aortic aneurysm.

Airway compression due to distal aortic arch and descending aortic aneurysm repair has been documented. This case of tracheal and left main stem bronchus compression due to aortic aneurysm occurred in a 42‑year‑old man. The airway compression poses a challenge for the anesthesiologist in airway management during aortic aneurysm repair surgery. The fiber‑optic bronchoscope is very helpful in decision‑making both preoperatively and postoperatively in such cases. We report a case of airway compression in a 42‑year‑old patient who underwent elective distal aortic arch and descending aortic aneurysm repair.

A comparative study between propofol and etomidate in patients under general anesthesia / Estudo comparativo entre propofol e etomidato em pacientes sob anestesia geral

ABSTRACT BACKGROUND AND OBJECTIVES: Induction of anesthesia is a critical part of anesthesia practice. Sudden hypotension, arrhythmias, and cardiovascular collapse are threatening complications following injection of induction agent in hemodynamically unstable patients. It is desirable to use a safe agent with fewer adverse effects for this purpose. Present prospective randomized study is designed to compare propofol and etomidate for their effect on hemodynamics and various adverse effects on patients in general anesthesia. METHODS: Hundred ASA I and II patients of age group 18-60 years scheduled for elective surgical procedure under general anesthesia were randomly divided into two groups of 50 each receiving propofol (2 mg/kg) and etomidate (0.3 mg/kg) as an induction agent. Vital parameters at induction, laryngoscopy and thereafter recorded for comparison. Adverse effect viz. pain on injection, apnea and myoclonus were carefully watched. RESULTS: Demographic variables were comparable in both the groups. Patients in etomidate group showed little change in mean arterial pressure (MAP) and heart rate (HR) compared to propofol (p > 0.05) from baseline value. Pain on injection was more in propofol group while myoclonus activity was higher in etomidate group. CONCLUSIONS: This study concludes that etomidate is a better agent for induction than propofol in view of hemodynamic stability and less pain on injection.

RESUMO JUSTIFICATIVA E OBJETIVOS: A indução é uma parte crítica da prática de anestesia. Hipotensão súbita, arritmias e colapso cardiovascular são complicações ameaçadoras após a injeção de agente de indução em pacientes hemodinamicamente instáveis. É aconselhável o uso de um agente seguro com menos efeitos adversos para esse propósito. O presente estudo prospectivo, randômico, teve como objetivo comparar propofol e etomidato quanto a seus efeitos sobre a hemodinâmica e aos vários efeitos adversos em pacientes sob anestesia geral. MÉTODOS: Cem pacientes ASA I e II, entre 18-60 anos, programados para procedimento cirúrgico eletivo sob anestesia geral, foram divididos aleatoriamente em dois grupos de 50 cada para receber propofol (2 mg/kg) e etomidato (0,3 mg/kg) como um agente de indução. Os parâmetros vitais na indução, laringoscopia e posteriormente foram registrados para comparação. Efeitos adversos como dor à injeção, apneia e mioclonia foram cuidadosamente monitorados. RESULTADOS: As variáveis demográficas foram comparáveis em ambos os grupos. Os pacientes do grupo etomidato apresentaram pouca alteração da pressão arterial média (PAM) e da frequência cardíaca (FC) em comparação com o grupo propofol (p < 0,05) a partir do valor basal. Houve mais dor à injeção no grupo propofol, enquanto houve mais atividade mioclônica no grupo etomidato. CONCLUSÕES: Este estudo conclui que etomidato é um agente melhor para a indução do que o propofol em relação à estabilidade hemodinâmica e menos dor à injeção.

Antihypertensive drug utilization pattern and awareness in diabetic hypertensive patients at tertiary care centre.

Background: Patients with diabetes has 2 fold higher chances of suffering from hypertension. Hypertension is risk factor for development of diabetes as well for complications like nephropathy, CAD and neuropathy etc. Hypertension control is vital to prevent and retard progression of microvascular and macrovascular complications. Therefore, we undertook this study to evaluate treatment patterns in diabetic patients with hypertension, those are being followed at our institute. Methods: Study group comprised of diabetic patients who had hypertension as well. All patients with diabetes reporting to medicine OPD from March 2014 to September 2014 at our institute were screened. Patients with follow up of at least 3 months and age more than 18 years of either sex were included. Results: There were 223 patients. Study group comprised of 121 males and 102 females. Mean age of group was 48.6 years. One hundred three patients (46.18%) were on monotherapy and remaining 120 patients were on combination antihypertensive drugs. There were total 398 antihypertensive drug exposures. Patient needed mean antihypertensive drug of 1.78. Angiotensin receptor blockers were the most commonly prescribed drugs. Angiotensin inhibitors (angiotensin receptor blockers and ACE inhibitors) were utilized in 158 (71%) patients. Hypertension control was achieved in 84 (37.66%) patients. One hundred eighty one patients (81.2%) knew about disease. Conclusion: Our study showed that majority of diabetic hypertensive patients needed multiple drug therapy to control hypertension. Most of the patients were on ARBs/ACE inhibitors. This was according to recommendation by ADA or JNC8.

Prevalence of goitre among school going children in urban area of Dehradun.

Background: Iodine is an important micro-nutrient required for human nutrition. Iodine Deficiency Disorders (IDDs) are one of the major world-wide public health problems of today which causes wide spectrum of disabilities. It includes impairment of reproductive functions, lowering of IQ levels in school age children, goiter, deaf mutism, mental defects, weakness and paralysis of muscles as well as lesser degree of physical dysfunction. Methods: Selection of population: The school children in age group of 6-18 years from both the sexes were screened from SGRR Schools of different locations at Dehradun, after taking approval from principal and the parents. Results: The prevalence of goitre among school going children was 5%. Prevalence of goitre among female was 6.4% compare to male were 4.1%. There was significant association found between prevalence of goitre and vegetarian diet. In pre pubertal age (11-14 years) maximum (7.6%) cases of goitre were seen. A significant association of goitre with pallor was also observed Conclusion: The sustained efforts in implementing the guidelines of National Iodine Deficiency Disorders Control Programme (NIDDCP) have been able to reduce the prevalence of goitre in Uttrakhand state. In spite of reduction in prevalence over years, goitre continues to be a major public health problem in the state.

Clinical profile and outcome of Hantavirus infection with renal involvement in India.

Background: Hantavirus infections are found all over world but there is paucity of information about clinical features of Hantavirus infection in India. Aim of current study was to study clinical profile and outcome of patients with Hantavirus infection and renal insufficiency who presented at our institute. Methods: All patients who were admitted in department of medicine with Hantavirus infection and renal insufficiency were included. Their basic demographic profile with relevant laboratory investigations was recorded. They were diagnosed with Hantavirus infection if they had positive IgM antibodies by ELISA test. Results: There were seven patients with mean age of 54 years. They had mean serum creatinine level of 4.37 ± 1.86 mg%. All had thrombocytopenia and hepatic dysfunction as well. Five patients had hypotension. There was need of dialysis in three patients. They also had hypoalbuminemia. No patient had features suggestive of acute respiratory distress syndrome. All patients had recovery of renal function and there was no mortality. Conclusion: Patients with Hantavirus infection presented like hemorrhagic fever with renal syndrome. Their outcome is good. We need to suspect Hantavirus infection in appropriate clinical scenario in India.

Histone deacetylase inhibitors: pharmacotherapeutic implications as epigenetic modifier.

Epigenetic modifications such as acetylation and deacetylation of histone proteins play a decisive role in transcriptional alteration and expression of genes. Acetylation is catalysed by the histone acetyl transferases enzymes and activates expression of genes by converting chromatin into a less compact, transcriptionally active state. Histone deacetylases enzymes catalyze deacetylation that condenses chromatin into a closed structure .Consequently transcriptional factors are unable to access DNA and gene expression is suppressed. Balanced activity of HATs and HDACS is essential for normal gene expression. Increased HDAC activity can lead to imbalance in protein acetylation resulting in hypoacetylation, tight chromatin structure and suppression of various genes. This aberrant suppression of genes is the hallmark of several malignant and other diseases including neurodegenerative disorders. Histone Deacetylase Inhibitors (HDACIs) have potential to restore the balance of histone acetylation that reverses the silencing of pathological genes. Thus HDACIs modify expression of genes without affecting sequence of DNA and act as epigenetic modifiers. Vorinostat and romidepsin are FDA approved HDACIs. Valproic acid, belinostat and many others are in different phases of clinical trials. This review article explores the target based epigenetic mechanisms as well as existing and potential therapeutic role of HDACIs in various malignant and non-malignant diseases. Data sources were articles published in medical journals and bibliographic database Medline.

A study of mastoid foramen in adult north Indian crania.

Background: Non metric cranial variants have always been a topic of considerable interest for research workers, as they possess racial, regional and sex dimorphic differences. These variants are also of anthropometric, genetic, morphological and forensic importance. Material and methods: 71 skulls from north indian region were studied for one of such variant, absence of mastoid foramen and presence of multiple mastoid foramen. Results: Incidence of absent mastoid foramen is 7.04 %, while bilateral incidence of absent mastoid foramen is only 1.4 %, however unilaterally mastoid foramen is absent in 5.63 %. (2.8 % on right side and 2.8 % on left side). Incidence of multiple mastoid foramina is 12.67 %, out of this it is bilateral in 8.45 %, however unilaterally it is present in 4.22 %. ( 1.40 % on right side and 2.81 % on left side).Conclusions: Findings are discussed and compared with other global studies and are found to be of considerable racial and regional significance. Knowledge of this variant is valuable in some neurosurgical and otolaryngeal procedures.