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Illegal mining activities have been rampant since decades. These activities have literally changed the face of the landscape. The mountains have disappeared, surface have been left dotted with deep mining pits, villagers have to live a substandard life due to the negative effects of mining in the form of decreased water quality, poor air quality, mining related accidents, damaged houses because of stone blasting and much more. The authorities have turned a blind eye towards the common man's problem and thus the residents of nearby villages are left with no choice but to live under silence. The unscientific and illegal mining practices in the south- west region of Haryana in the districts of Mehandargarh, Dadri and Bhiwani has altered the physical landscape and affected the socio cultural life of nearby villages to a great extent. The study is a step in the direction of describing how an anthropogenic activity if done without any rules and order and in unscientific manner can affect the environment to unimaginable
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Purpose: To evaluate the clinical profile and screening guidelines of retinopathy of prematurity (ROP) in an urban level III neonatal intensive care unit (NICU). Methods: Infants with ?2000?gm birth weight or <34 weeks gestational age were prospectively screened for ROP in an urban level III NICU between January 2018 and December 2020, based on national screening guidelines. Standard guidelines were used for ROP classification and treatment. Results: In total, 211 infants completed screening; 46 (21.8%) infants developed ROP and 13 (6.2%) had type 1 (laser treatable) ROP. Of the 46 infants with ROP, 44 (95.65%) had zone 2 and two (4.34%) had zone 1 disease. In the 102 infants with ?1500?gm birth weight, the incidence of ROP and type 1 ROP were 41.18% and 11.76%, respectively. Out of the 109 infants with >1500?gm birth weight, four (3.67%) developed ROP and one (0.91%) infant (an outborn) required treatment. Conclusion: The majority of infants developing ROP in a level III urban NICU had ?1500?gm birth weight. Zone 1 ROP was uncommon. Incidence of ROP in heavier infants (>1500?gm birth weight) was low, and treatment was required in a rare instance. In an urban NICU, the burden of ROP screening and treatments shifts to small and low?birth?weight infants
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Objectives: This study evaluated the perception and practices of health care providers (physicians, diabetologists, and endocrinologists) regarding the treatment of hypertension in patients with diabetes in India. Methods: Health care providers throughout India who treated patients with diabetes and hypertension were invited to participate in an online survey and periodic 21 virtual meetings. They were questioned about their perception and practices in managing these patients, and strategies to improve blood pressure (BP). Results: The online survey was completed by 2,513 health care providers, and 344 participated in virtual meetings. More than 50% reported that 31–50% of their patients with diabetes also had hypertension. Home BP monitoring was recommended by 88%, and lifestyle modifications were consistently recommended. Choice of antihypertensive treatment varied based on comorbidities, and a renin–angiotensin system blocker plus a calcium channel blocker (CCB) was the most common combination for dual antihypertensive therapy. Suggested strategies to improve BP control included patient awareness/education, lifestyle modifications, better follow-up/monitoring, and optimization of therapy. Conclusion: Indian health care providers were aware of clinical recommendations and practices regarding treatment of patients with diabetes and hypertension, and generally make clinical decisions consistent with current guidelines. Optimization of care for these patients is essential to reduce cardiovascular disease risk and improve patient outcomes.
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Cholecystectomy preferably laparoscopy is gold standard treatment for symptomatic cholelithiasis. However for some anatomical and/or pathological reasons the procedure is converted to open. Conversion rates at high volume centres is <5%. We present a case report of 48 aged lady, previously operated multiple times for hydatid liver and lung with symptomatic cholelithiasis. She was planned for laparoscopic cholecystectomy. During the procedure, inadvertent anatomy of “the wandering gallbladder” was noted. Here we describe the management approach selected for this type of unusual presentation. We recommend noting down detailed past history (preferably surgical) and preoperative consideration of deviant anatomical location and findings of gallbladder. We should maintain a low threshold for conversion to open.
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Background: Laparoscopic cholecystectomy and laparoscopic appendectomy is gold standard treatment modality for symptomatic cholelithiasis and appendicitis. Laparoscopy in paediatric patient have many limitations and factors restricting its use in paediatric patient are smaller surface area for access, compliant abdominal wall, the liver margin below the rib cage, the bladder being an intra-abdominal structure, the viscera close to anterior abdominal wall and small sized abdominal cavity and conventional instruments too long for paediatrics use. The so-called obliterated structures like umbilical vein, umbilical artery and urachus remain relatively large and partially patent in infants further restricting use of therapeutic laparoscopy.Methods: The present study was carried out in Department of General Surgery, MDM Hospital, Dr. S. N. Medical College, Jodhpur, Rajasthan. Total 50 patients were included in the present study of laparoscopic surgery in paediatric patients below 14 years of age and were studied in terms of, duration of surgery, postoperative pain, analgesic requirement, postoperative hospital stay, intraoperative and postoperative complication and factors necessitating conversion of laparoscopic procedure to open method.Results: As per the present study inguinal hernia was most common diagnosis (48%) followed by hydrocele (22%) and acute appendicitis (22%).Conclusions: It is concluded from the present study that laparoscopic surgery in paediatric patients is safe, complication free, had less analgesic requirement, shorter duration of surgery, short postoperative hospital and total hospital stay and better cosmetic results.
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Background: The modern day oral oncotherapy is now concerned on the oral quality of life after treatment of the patient. There is need to evaluate final outcome following the different combination of treatment modalities available to make better therapeutic treatment decisions. Oral health-related quality of life (QHRQOL) and their nutritional status is gaining importance as a valuable outcome measure in oral cancer area and compare with the other control group. The aim of the study was to examine the nutritional status among the oral cancer patients and compare the QHRQoL of two groups (i.e., oral cancer group and control group) in Varanasi district.Methods: The prospective study was conducted from January 2018 to August 2018. 124 oral cancer patients and 124 control people from the Varanasi district participated in this study. Nutritional status of oral cancer treated patients was assessed. QHRQoL of the oral cancer patients were compared with the control group.Results: Among the 124 oral cancer patient, 67.74% were malnourished or at risk of malnutrition. Patients had worse QHRQoL among oral cancer group. There were highly statistically significant differences found in the oral health impact profile and oral impacts on daily performances on comparing the oral cancer patients with the control group.Conclusions: This study indicated that oral cancer patients with malnutrition or risk of malnutrition have significantly worse OHRQoL than with the control population group.
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Background: Routine screening for distress is internationally recommended as a standard of care among cancer patients. This study was conducted to assess the level of stress and determine the association between quality of life (QOL) with demographic, socio-economic status, treatment phase, cancer stage, etc.Methods: An observational study, performed in the department of Clinical Oncology, Nayati Multi Super Speciality Hospital, Mathura, India. Data of 62 histopathologically proven cancer patients between Nov 2016 and July 2018, were analyzed. This pilot study was conducted to assess the QOL and stress levels of cancer patients by using scales of WHOQOL-BREF, QSC-R23 and Hamilton scale. Results: Among 62 cancer patients, high distress along with poor QOL was seen maximum in males, 40-60 year age group and educated. In majority of domains, high distress was found in middle class, whereas poor QOL was found in Lower class in Environmental domain (p<0.01). We found higher distress in nuclear families (p<0.05). High distress was seen in cancer patients who were aware of illness and was found to statistically significant. Poor QOL in stage 4 was found to be statistically significant in Psychological domain of WHOQOL-BREF. High distress was found in patients undergoing treatment in all patients as compared to Pre-treatment phase and Post-treatment phase (p<0.05).Conclusion: To assess psychological stress in cancer patients using all three scales we could not obtain a conclusive result covering all dimensions of QOL. So, in our next study authors plan to develop one indigenous new scale.
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Background: The accuracy of radiotherapy is based on the matching of 2D portal/CBCT image with a reference image. The aim of this study is to determine the random and systematic setup errors (in cm) in radiotherapy of head and neck cancer patients and to derive the setup margin and its clinical implications.Methods: Author retrospectively reviewed the records of 25 head and neck cancer (HNC) patients treated with radiotherapy between Dec 2017 and July 2018. After immobilization, setup accuracy was assessed by registration of XVI image with planning reference image using Elekta XVI image guidance system and the isocenter correction was applied. For each patient 10 CBCT image sets were taken. The translational errors in X, Y and Z directions were used to estimate systematic (Σ) and random (σ) errors and to derive the final setup margin by using van Herk’s formula (2.5Σ + 0.7σ).Results: The mean translational errors ranges from -0.23 cm to 0.32 cm in Lateral (X), -0.15 to 0.16 cm in Longitudinal (Y) and -0.11 to 0.17 cm in vertical (Z) directions. The Mean and SD for systematic errors 0.21±0.13, 0.11±0.18, 0.14±0.11 and random error (in cm) are -0.03±0.33, 0.00±0.21 and 0.05±0.30 in X, Y and Z axis respectively. The final total margin for CTV to PTV including setup margin in the X, Y and Z directions (in cm) were 0.56, 0.61, and 0.47 respectively.Conclusion: Thus, the precise immobilization techniques are very important to reduce the setup margins, and the number of CBCTs during head and neck radiotherapy treatment.
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Background: Epilepsy is widespread in developing countriescompared to that in developed countries. The reason ofepilepsy in most cases is unknown. Considering the factthat the nutritional status of children in developing countriesis generally poor, our objective was to determine possiblerelationship between nutritional status and epilepsy.Material and methods: Towards this, we gather a datasetof 34 Cases from the Department of Pediatric and as manyControls from the local populace. The age group (5-8.5 years),sex, and gender data is also augmented with educationaland socioeconomic history along with the results of clinicalexaminations, such as, weight, height and body mass index.Results: Our statistical results unveil insignificantdifference in socioeconomic status and educational levels inbetween the parents of Cases and Controls. Additionally, asignificantly higher value of anthropometric measurementsin Controls is observed compared to that of the Casesi.e.Height (117.38±6.05 vs. 112.21±6.82 cm; p value 0.002),Weight (21.29±2.83 vs. 18.14±2.94 kg; p value <0.001) andBody mass index(15.39±1.03 vs.14.33±1.26 kg/m2; p value<0.001).Conclusion: Our results show that generalized epilepsymay have effect on growth and development of children,reflecting that nutritional programs are required to improvethe nutritional status in children with generalized epilepsy soas to optimize their growth and development.
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Background: Diabetes has been on the rise since last decade or so with prevalence rate changing as more research is being done. India is one of the most burdened country from diabetes specially type 2. With changing life style other diseases are also on the rise and evidence is being generated to find tangible association. One such disease is periodontitis. As evidence from the State of Bihar for association between periodontitis and diabetes mellitus is negligible this study was conducted to find the same.Methods: A cross sectional observational study in community settings was done for three months on 200 diabetic willing participants. Data was generated using a semi structured pretested questionnaire. Data analysis was done using SPSS version 22.0 and statistical measures of central tendency like mean, mode, median and standard deviation were used. For establishing association chi square tests were used. P values<0.05 were considered to be statistically significant.Results: 61.5% of the participants were male while 65.5% were from rural area. The study population was on an average on the older side with a mean age of 52±12.15 and on the bulky size with a BMI of 28.85±4.08. Authors got the average Russel’s score to be 1.1±1.79. The mean blood sugar level for fasting was 146.40±59.99 and post prandial levels was 211.59±82.49. A Russel score category of established periodontal disease and terminal disease was present in 77.5% of participants having an altered fasting blood sugar level. Majority of the males had established periodontal disease and terminal disease. Patients with elevated postprandial blood sugar levels had more established periodontal disease and terminal disease.Conclusions: Oral health is definitely associated with diabetes mellitus type 2 and its other factors like duration, glycaemic control, blood sugar levels etc. Public awareness regarding this is minimal. More research and awareness regarding this will help in keeping the diabetic population healthy.
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One unknown impurity(Imp-II)during the analysis of laboratory batches of isoproterenol hydrochloride was detected in the level ranging from 0.04% to 0.12% by high performance liquid chromatography with UV detection. The unknown impurity structure was proposed as 4-[2-(propan-2-ylamino)ethyl]benzene-1,2-diol (Imp-Ⅱ)using the liquid chromatography–mass spectrophotometry(LC–MS)analysis.Imp-Ⅱ was isolated by semi-preparative liquid chromatography from the impurity-enriched reaction crude sample. Its proposed structure was confirmed by nuclear magnetic spectroscopy such as 1H, 13C,DEPT(1D NMR),HSQC(2D NMR) and infrared spectroscopy(IR),and retention time and purity with HPLC followed by the chemical synthesis. Due to less removable nature of Imp-II during the purification,the synthetic process was optimized proficiently to control the formation of Imp-II below to the limit<0.12% in the course of reaction.The new chemical route was developed for the preparation of this impurity in required quantity with purity to use as reference standard. The most probable mechanism for the formation of Imp-II was discussed in details.
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Introduction: Acute Kidney Injury is a common medical problem. AKI is responsible for major mortality and morbidity of hospitalized patients because of serious nature of the underlying illness and incidences of complication. Materials and methods: A total number of 100cases of Acute Kidney Injury who fulfill the inclusion criteria were studied with a detail history, clinical examination and investigation according to need. Results: Out of 100 patients 78 were male and 22 were female. Maximum numbers of patients were in age group of 51 to 60 years. Vomiting (60%) and Oliguria (48%) were common presenting features. The study showed various etiological factor associated with Acute Kidney Injury like Septicemia (43%), Acute gastroenteritis (10%), Malaria (9%), Nephrotoxicity (8%), Cirrhosis of Liver and Obstetrical cause cause (7%), Glomerolonepritis (6%), CCF (5%), Snake bite (4%), and Leptospirosis (1%). In this study, Hypotension (40%) were common complication of acute kidney injury followed by Hyperkalemia (35%). Conclusion: We observed that early diagnosis and early investigation were probably responsible for good survival rate in acute kidney Injury
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Repair of congenital heart disease in the presence of high pulmonary pressure has always been a contentious issue. Pulmonary vascular resistance (PVR) is considered important for establishing operability in these patients. However, PVR estimation is not always accurate and cannot solely be relied upon to make critical decision of operability. Clinical examination, chest X‑ray, and echocardiography are also important indicators of pulmonary vascular disease. Knowledge of pits and falls of each investigation is important for appropriate management in these patients. We present a case report of successfully operated, 6‑year‑old child with anomalous origin of the right pulmonary artery from aorta, deemed inoperable on the basis of PVR estimation.
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ABSTRACT In search of lead molecules for use in disease prevention and as food additive from natural sources, two flavanols were isolated from leaves of Anthocephalus cadamba (Roxb.) Miq., Rubiaceae. Their structures were established as 6-hydroxycoumarin-(4"→8)-(-)-epicatechin and 6-hydroxycoumarin-(4"→8)-(-)-epicatechin-(4→6‴)-(-)-epicatechin on the basis of spectroscopic data. Both the compounds exhibited potent antioxidant and antigenotoxic activity. 6-Hydroxycoumarin-(4"→8)-(-)-epicatechin scavenged DPPH, ABTS+.and superoxide anion radicals with IC50 values of 6.09 µg/ml, 5.95 µg/ml and 42.70 µg/ml respectively whereas the IC50 values for 6-hydroxycoumarin-(4"→8)-(-)-epicatechin-(4→6‴)-(-)-epicatechin were 6.62 µg/ml for DPPH free radicals, 6.93 µg/ml for ABTS radical cations and 49.08 µg/ml for superoxide anion radicals. Both the compounds also exhibited potent reducing potential in reducing power assay and protected the plasmid DNA (pBR322) against the attack of hydroxyl radicals generated by Fenton's reagent in DNA protection assay. In SOS chromotest, 6-hydroxycoumarin-(4"→8)-(-)-epicatechin decreased the induction factor induced by 4NQO (20 µg/ml) and aflatoxin B1 (20 µg/ml) by 31.78% and 65.04% respectively at a concentration of 1000 µg/ml. On the other hand, 6-hydroxycoumarin-(4"→8)-(-)-epicatechin-(4→6‴)-(-)-epicatechin decreased the genotoxicity of these mutagens by 37.11% and 47.05% respectively. It also showed cytotoxicity in COLO-205 cancer cell line with GI50 of 435.71 µg/ml. Both the compounds showed moderate cyclooxygenase-2 inhibitory activity.
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Pulmonary arterial hypertension (PAH) is a life-threatening and progressive disease characterized by pulmonary vascular remodeling that leads to increased pulmonary vascular resistance and pulmonary arterial pressure, most often resulting in right-sided heart failure. Originally considered to be a disorder of vasoconstriction and vasodilatation, it has become clear that the predominant characteristic of PAH is abnormal cellular proliferation leading to progressive obliteration of the pulmonary vasculature. Current PAH-specific therapies target one of three major pathways involved in development and progression of PAH: 1) The endothelin pathway targeted by the endothelin receptor antagonists (ERAs); 2) the prostacyclin pathway, targeted by prostacyclin analogs and 3) the nitric oxide (NO) pathway, targeted by the phosphodiesterase type 5 (PDE-5) inhibitors.
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Cardiovascular disease is a leading cause of death worldwide. Coronary heart disease (CHD) caused by atherosclerosis is the most common cause of morbidity and mortality. Prevention, stabilization and regression of atherosclerotic plaques may have a major impact on reducing the risk of acute coronary events. Low-density lipoprotein-cholesterol (LDL-C) lowering agents, primarily the statins, are the current mainstay in the pharmacologic management of dyslipidemia. Epidemiologic and observational studies have shown that high-density lipoprotein-cholesterol (HDL-C) is also a strong independent predictor of CHD, suggesting that raising HDL-C levels might afford clinical benefit in the reduction of cardiovascular risk. HDL particles have key atheroprotective functions—including the capacity to efflux cellular cholesterol—in addition to having antioxidative, anti-inflammatory, antiapoptotic, antithrombotic and vasodilatory actions. Therapeutic approaches to raise HDL-C levels can target one or more of several mechanisms, including the production of apolipoprotein A-I (apoA-I) or modification of intravascular remodeling of HDL particles. However, the landscape of HDL-raising therapies is now littered with failed therapies, including niacin and the negative results with the cholesteryl ester transfer protein (CETP) inhibitors. This is attributed to potential adverse effects of CETP inhibition such as the generation of HDL particles that have deficient biological activities and a deleterious impact on reverse cholesterol transport and steroid metabolism. Normalization of both defective HDL function and diminished HDL levels should, therefore, be the focus of pharmacological HDL-raising in future studies.
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Background: Umbilical venous lines are sometimes complicated with pleural and or pericardial effusion, often due to line migration. Case Characteristics: Bilateral chylous pleural effusion without pericardial effusion in a 28 weeks, extremely low birth infant who was on total parenteral nutrition. Observations/Investigations: Investigations including chest x ray and 2D echocardiogram showed bilateral chylous pleural effusions but appropriate tip position of the umbilical venous line. Outcome: Removal of the umbilical venous line and cessation of total parenteral nutrition resulted in complete resolution of the pleural effusion. Message: In any newborn with central venous catheter in situ, acute deteriorations specially, those related to pleural and pericardial effusions should alert the clinicians to remove the catheter and should not be misguided by apparently appearing normal correct catheter position by x-ray or 2D echocardiogram.
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Studies on host genomics have revealed the existence of identifiable HIV-1 specific protective factors among infected individuals who remain naturally resistant viraemia controllers with little or no evidence of virus replication. These factors are broadly grouped into those that are immune associated (MHC, chemokines, cytokines, CTLs and others), linked to viral entry (chemokine co-receptors and ligands), act as post-entry restriction elements (TRIM5a, APOBEC3) and those associated with viral replication (cytokines and others). These features have been identified through multiple experimental approaches ranging from candidate gene approaches, genome wide association studies (GWAS), expression analysis in conjunction with functional assays in humans to primate based models. Several studies have highlighted the individual and population level gross differences both in the viral clade sequences as well as host determined genetic associations. This review collates current information on studies involving major histocompatibility complex (MHC) as well as non MHC genes in the context of HIV-1 infection and AIDS involving varied ethnic groups. Special focus of the review is on the genetic studies carried out on the Indian population. Further challenges with regard to therapeutic interventions based on current knowledge have been discussed along with discussion on documented cases of stem cell therapy and very early highly active antiretroviral therapy (HAART) interventions.
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Tinospora cordifolia is used in Ayurveda as "Rasayanas" to improve the immune system and the body resistance against infections. Polysaccharides are the main constituents which are considered to be responsible for immune enhancement. In this study, immunomodulatory activity of three polysaccharide enriched fractions was evaluated using the polymorphonuclear leukocyte function test. Sugar composition was determined by GC-MS analysis of the derivatised fractions. The active polysaccharide fractions mainly constitute glucose, fructose and arabinose as monomer units.
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Objective: To evaluate the analgesic, anti-inflammatory and antipyretic activity of methanolic Tecomaria capensis (T. capensis) leaves extract using different models in rats. Methods:Methanolic T. capensis leaves extract (100, 300, 1000 and 2000 mg/kg body weight) was given to rats orally to observe acute toxicity, and observed for 14 days. Analgesic activity was evaluated using tail immersion and formalin induced paw licking models in rats. Anti-inflammatory activity was evaluated using carrageenan induced paw edema model in rats. Antipyretic activity was evaluated using brewer’s yeast induced pyrexia model in rats. Methanolic T. capensis leaves extract were given at dose of 100, 200 and 500 mg/kg p.o. Results: Results demonstrated that the no mortality was reported even after 14 days. This indicated that the methanol extract was safe up to a single dose of 2000 mg/kg body weight. Methanolic T. capensis leaves extract (100, 200 and 500 mg/kg p.o.) significantly increased the latency period in the tail immersion test, reduced the licking time in both the neurogenic and inflammatory phases in the formalin test. Methanolic T. capensis leaves extract (100, 200 and 500 mg/kg p.o.) significantly prevented increase in volume of paw edema. Methanolic T. capensis leaves extract at the doses of (100, 200 and 500 mg/kg p.o.) significantly decreased the rectal temperature of the rats. Conclusions: This study exhibites that methanolic T.capensis leaves extract possesses analgesic, anti-inflammatory and antipyretic activity which may be mediated by the central and peripheral mechanisms.