Epicardial pacemaker insertion in a preterm very low birth weight neonate – An anaesthetic challenge

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.

Addressing adenomyosis: Implications beyond we actually know

Background: Hysterectomy is one of the commonest gynecological surgeries being performed in India for various pelvic pathologies like fibroid uterus, endometrial hyperplasia, dysfunctional uterine bleeding, etc. But pre-operative diagnosis of adenomyosis and making it an indication for hysterectomy is not as common as pathologists find it in histo-pathology of hysterectomized specimens. The aim of the study was to study the frequency of adenomyosis in comparison to leiomyoma as a uterine pathology in hysterectomized specimens and correlate them clinically.Methods: A retrospective comparative study was carried out on 1646 hysterectomy specimens, during January 2014 to December 2016, which showed either adenomyosis or leiomyoma or both. Clinical records of these cases were retrieved and histo-pathology was correlated to clinical presentations and pre-operative ultrasonography.Results: Of the 1646 specimens taken for comparision between adenomyosis and leiomyoma, 49% showed only adenomyosis, 37% only leiomyoma and 14% had dual pathology showing findings of both. The peri-menopausal age group (45-54 years) accounted for the maximum number of patients undergoing hysterectomy (37.12%). But adenomyosis was found maximum in 35 - 44 years age group (38.04%). The clinical presentations for these two pathologies were similar and maximum patients presented with abnormal uterine bleeding and pelvic pain. Ultrasonography was able to diagnose only 32% cases of adenomyosis pre-operatively whereas this figure was 87% for fibroids.Conclusions: Adenomyosis and leiomyoma both account for the most frequent findings in hysterectomy specimens. Fibroids are easily diagnosed pre-operatively, but adenomyosis needs to be diagnosed pre-operatively by high index of clinical suspicion and imaging techniques. Adenomyosis is not just a disease of middle age, it needs to be addressed for infertility, recurrent pregnancy loss (RPL), bad obstetric history, IVF failures and adherent placenta as well.

Probing the mechanism of the anti-diabetic potential of a terpenoid from Elephantopus scaber L., an Indian ethnomedicinal plant in STZ diabetic rats- In vivo and in silico analysis

Plants have always been an exemplary source of drugs and many of the currently available drugs have been derived directly or indirectly from them. Since ancient times, traditional medicines all over the world have advocated the use of plants to treat diabetes. Elephantopus scaber L. assumes significance because it has shown by us to possess high hypoglycemic effect and justifies the traditional claims of being anti-diabetic drug candidate. The terpenoid isolated from Elephantopus scaber L. demonstrated promising antihyperglycemic property with an increase in insulin levels but the mode of action had not been investigated. Since increased insulin levels are associated with β-cells of the pancreas, histological studies were undertaken to evaluate the effect of the compound on β-cells protection in streptozotocin induced diabetic rats. Streptozotocin is known to cause damage to β-cells and hence the protective and curative role of terpenoid was evaluated on the restoration of β-cells. The regeneration of damaged β-cells on the administration of the terpenoid is evident from histological and ultra-structural investigations. In histological observations, islets of extract-treated diabetic rats are seen to have numerous cells with normal histoarchitecture. Ultrastructural studies revealed β-cells of compound-treated diabetic rats to contain granulated secretory vesicles. The plant may act independently or synergistically to regenerate the damaged endocrine pancreas and thereby stimulation of insulin secretion in β-cells as revealed by LM and TEM. To further confirm the mode of action of the compound, in silico docking with target proteins like PPARγ, which plays a role in protecting β-cells from damage was undertaken. The docking analysis in the active sites of 2PRG was performed by Schrodinger program. The docking results showed good binding interactions of the ligand with the target at the very low energy level. In our in silico analysis, terpenoid isolated from E. scaber clearly demonstrated that it could improve the diabetic condition by increasing insulin secretion from remnant or regenerated pancreatic β-cells and could promote insulin sensitization and glucose uptake activities, which was a supporting evidence to the histological studies. Thus the terpenoid from E. scaber can be considered for developing into a potent antidiabetic drug.

Electronic health records and outpatient cardiovascular disease care delivery: Insights from the American College of Cardiology’s PINNACLE India Quality Improvement Program (PIQIP)

Background There has been a push toward implementation of electronic health records (EHRs) in federally-funded hospitals under the current policies initiated by the Indian government, with a lack of evidence supporting their adoption. We analyzed data from the American College of Cardiology’s PINNACLE (Practice Innovation and Clinical Excellence) India Quality Improvement Program (PIQIP) to evaluate the association between EHR use and quality of cardiovascular disease care in India. Methods and Results Between 2011–2016, we collected data on performance measures for patients with coronary artery disease (CAD), heart failure (HF) and atrial fibrillation (AF) among 17 participating practices in PIQIP. There were 19,035 patients with CAD, 9,373 patients with HF, and 1,127 patients with AF. Documentation of co-morbidity burden in patients with CAD was lower among practices with EHR—hypertension (49.8% vs. 52.1%, p = 0.003), diabetes (34.9% vs. 38.3%, p < 0.001), and hyperlipidemia (0.2 vs. 3.9%, p < 0.001). On the contrary, documentation of medication prescription was higher in CAD patients seen at practices with EHR—aspirin (63.2% vs. 17.8%, p < 0.001), clopidogrel (41.7% vs. 27.4%, p < 0.001), beta-blockers (61.4% vs. 9.8%, p < 0.001), and ACE-i or ARBs (53.9% vs. 16.4%, p < 0.001). Similarly, documentation of receipt of beta-blockers (43.8% vs. 10.7%, p < 0.001), ACE-i or ARBs (40.8% vs. 16.1%, p < 0.001), and beta-blockers + ACE-i or ARBs (36.4% vs. 3.6%, p < 0.001) was also significantly higher in patients with HF seen at practices with EHR. Among patients with AF, documentation of oral anticoagulation use was significantly higher among EHR practices—warfarin (42.5% vs. 26.1%, p < 0.001). Conclusions Documentation of receipt of guideline-directed medical therapy in CAD, HF, and AF was significantly higher in practices with EHRs in India compared with sites without EHRs. Our findings shed a spotlight on the value of EHRs in future health care policy-making in India with regard to widespread adoption of EHRs in primary and advanced specialty care settings across public and private sectors.

Idiopathic Musculoskeletal Pain in Indian children-Prevalence and Impact on Daily Routine / Prevalência e impacto nas atividades diárias da dor musculoesquelética idiopática em crianças da Índia

ABSTRACT Objectives: To study the prevalence of idiopathic musculoskeletal pain (IMSP) in school going children and its impact on daily life. Methods: One thousand eighteen apparently healthy school children aged 5–16 years were assessed and analysed for IMSP and its associated problems. Standard tests for significance were applied. Results: One hundred and sixty-five (16.2%) children mostly males (55.2%) reported IMSP. Lower limbs (52.1%) were the most common location of pain. More than 1 year of pain history was present in 15%. Thirty-seven percent children complained of discomfort during walking, 30.9%, had pain during physical exercise, 29.2% had difficulty attending lessons and 4.2% had interference in pursuing hobbies. The children were also further sub grouped into preadolescents and adolescents. There was significant difference in pain duration and duration of each pain episode in the two groups (p = 0.01). A significant number of children (21.2%) with IMSP reported school absenteeism (p < 0.001). A significant number of adolescents had history positive for contact sports (p = 0.001). Sleep disturbances were also reported to be higher in children with IMSP (29% vs. 5.7%, p = 0.001). Other associated problems in children with IMSP found were day time tiredness (51.1%), headache (47.3%) and abdominal pain (24.8%). Conclusions: Prevalence of IMSP in school children aged 5–16 yrs was found to be 16.2% and a significant percentage of these children experience interference with daily activities including school absenteeism.

RESUMO Objetivos: Estudar a prevalência de dor musculoesquelética idiopática (DMEI) em crianças em idade escolar e seu impacto nas atividades diárias. Métodos: Foram avaliadas e analisadas 1.018 crianças em idade escolar aparentemente saudáveis entre cinco e 16 anos quanto à presença de DMEI e seus problemas associados. Foram aplicados os testes de significância padrão. Resultados: Relataram DMEI 165 (16,2%) crianças, em sua maior parte do sexo masculino (55,2%). Os membros inferiores (52,1%) foram a localização mais comum da dor. A história de dor presente havia mais de um ano foi encontrada em 15% das crianças; 37% delas queixaram-se de desconforto durante a caminhada, 30,9%, tinham dor durante o exercício físico, 29,2% tinham dificuldade de frequentar as aulas e 4,2% sofriam interferência na participação em passatempos. As crianças foram ainda subagrupadas em pré-adolescentes e adolescentes. Houve diferença estatisticamente significativa na duração da dor e na duração de cada episódio de dor nos dois grupos (p = 0,01). Uma quantidade significativa de crianças com DMEI (21,2%) relatou absentismo escolar (p < 0,001). Uma quantidade significativa de adolescentes tinha história positiva de prática de esportes de contato (p = 0,001). Os distúrbios do sono também foram relatados como maiores em crianças com DMEI (29% vs. 5,7%, p = 0,001). Outros problemas associados encontrados em crianças com DMEI foram o cansaço durante o dia (51,1%), a cefaleia (47,3%) e a dor abdominal (24,8%). Conclusões: A prevalência de DMEI encontrada em crianças entre cinco e 16 anos foi de 16,2%. Uma percentagem significativa dessas crianças relata interferência nas atividades diárias, incluindo absentismo escolar.

Galactosylated albumin nanoparticles of simvastatin

The present study was an attempt to develop galactosylated albumin nanoparticles of Simvastatin for treatment of hypercholesterolemia. By developing the galactosylated nanoparticulated delivery, the required action of the drug at the target site at the liver can be provided. The advantage of targeting helps to reduce the systemic side effects that may occur due to the distribution of the drug to the other organs and thus helps in maintaining the required concentration of drug at the desired site. The galacotsylated albumin nanoparticles were prepared for the selective delivery of a Simvastatin to the 3-hydroxy-3-methylglutaryl coenzyme A reductase [HMG-CoA reductase] the rate-limiting enzyme in the pathway of cholesterol biosynthesis that is particularly presents on hepatocytes. The asialoglycoprotein receptor [ASGP-R] which is particularly presents on mammalian hepatocytes can be utilize for active targeting by using its natural and synthetic ligands. By utilizing this receptors can provides a unique means for the development of liver-specific carriers, such as liposomes, recombinant lipoproteins, and polymers for drug or gene delivery to the liver, especially to hepatocytes. These receptors recognize the ligands with terminal galactose or N-acetylgalactosamine residues, and endocytose the ligands for an intracellular degradation process. The albumin nanoparticles [NPs] were prepared by using desolvation method and efficiently conjugated with galactose. Various parameters such as particle size, zeta potential, percentage entrapment efficiency and drug loading efficiency, percentage yield, in-vitro drug release were determined. The size of nanoparticles [both plain and coated NPs] was 200 and 250 nm. The zeta potential of plain nanoparticles was -3.61 and that of galactose-coated nanoparticles was 64.1. The maximum drug content was in between 79.98% to 79.8 % respectively in plain, and galactose coated nanoparticles while the maximum entrapment efficiency was 70.10% and 71.03% in plain and coated nanoparticles. It was found that coating of nanoparticles increases the size of nanoparticles

Experience of non-scalpel vasectomy in a rural area of Tamil Nadu.

Background. Only 0.7% of men participate in the sterilization programme in Tamil Nadu. Various strategies were adopted to achieve a target of 10%. We aimed to assess the motivational strategies adopted by the health staff of Sathya Vijayanagaram block of Thiruvannamalai district in Tamil Nadu to improve the acceptance of non-scalpel vasectomy among the beneficiaries and to describe the sociodemographic characteristics of the acceptors of the technique. Methods. This qualitative study, conducted in November– December 2010, involved in-depth interviews of the health staff of Cheyyar Health Unit district. All those who accepted non-scalpel vasectomy between 2007 and 2010 were interviewed. Results.Early identification of targets and sustained motivation through a team approach, supported by administrative arrangements and intense information–education– communication activities, resulted in non-scalpel vasectomy contributing to 13% of all sterilizations. Acceptors were men from lower socioeconomic strata. Conclusion. The strategies adopted by the health system have contributed to the acceptance of non-scalpel vasectomy in the remote villages of a block in Tamil Nadu. This endeavour may be replicated in other districts of Tamil Nadu and others states of India to achieve the goals set for population control.