China Ki String of Pearls ki Neeti V Bharatiya Suraksha

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Relationship of perceived sleep quality and stress among university students: An online survey during the COVID-19 pandemic

Background: Several factors cause mental stress during a pandemic where academic life is uncertain. This stress may cause a change in healthy behavior. Sleep is one of the important aspects and is deranged with physical or mental stress. Aim and Objectives: With this background, we conducted this study with university students to know the level of stress and sleep pattern and to find any correlation between them. Materials and Methods: This cross-sectional observational online survey study was conducted in Bhubaneswar, Odisha with 100 university students during the second wave of the COVID-19 pandemic. The stress was assessed with the COVID-19 Student Stress Questionnaire (CSSQ) and subjective sleep was assessed by Pittsburgh Sleep Quality Inventory (PSQI). Both the questionnaires were in English and were having Likert-type response options. The survey data were analyzed by Statistical test by GraphPad Prism 6.01 software package. Results: Among the participants, 66% had high stress, 24% had moderate stress, and 10% had low stress. The sleep quality analysis showed that 76% of students were having poor sleep and 24% had good sleep. There was a positive correlation between the CSSQ and PSQI score (r = 0.45, P < 0.0001). This indicates a strong correlation between stress and sleep quality. Conclusion: During a pandemic like the current COVID-19 pandemic, university students suffer from a high level of stress and disturbed sleep. Hence, to restore the wellbeing of the students, a proper sleep hygiene practice should be promoted that may eventually help reduce stress. On the other hand, proper information regarding academic progress and defined assessment methods may help reduce academic stress and promote good sleep.

Clinico-pathological and Immunophenotype Analysis of Hairy Cell Leukemia Cases – A Single Institute Experience

Background: Hairy cell leukemia is a mature lymphoid B cell disorder, characterized by hairy cells, a specific genetic profile, different clinical course and the need for an appropriate treatment. It is seen primarily in elderly, characterized by a triad of splenomegaly, pancytopenia and monocytopenia. Aim: To evaluate clinicopathologically and with immunophenotyping hairy cell leukemia cases received at our institute in conjunction with similar studies. Material and methods: This is a retrospective study which included 7 cases over a period of 3 years (2019-2021) confirmed on morphology and flow cytometry. Results: The study revealed 7 cases which showed patients with age ranging from 34-65 years. M:F ratio was 6:1. Two cases were covid positive (28.5%). Most of the cases presented with fever, weakness (28.5%). Splenomegaly was seen in three of the cases (42.6%). Laboratory investigations revealed anemia in 71% cases, leucopenia in 56.8%, lymphocytic prominence in 100% and pancytopenia in 14.2%. One patient presented with leukocystosis (14.2%). Marrow was hemodiluted and aparticulate in 3(42.6%) cases. Hairy cells were seen on morphology of peripheral smear and marrow aspirate. On flow cytometry, CD5 negative in all cases (100%), CD10 positive in 2(28.5%) and CD23 in 2 cases (28.5%). Few cases confirmed BRAF v600e mutations. Conclusion: Unusual findings like leukocytosis, absence of spleen, presence of lymphadenopathy can be present in hairy cell leukemia. Classical fried egg appearance in trephine biopsy may not be afeature in all the cases. CD123 is expressed in covid patients unlike other studies and further research is needed to establish the loss of CD123 in covid patients.

Linguistic and cultural adaptation of physical activity readiness questionnaire in Odia language

Background: Regular exercise and proper exercise are two important measures that can control obesity reduce the chances of metabolic disease and promote a healthy life. Many a time, exercise may not be suitable for some individuals. For screening, a Physical Activity Readiness Questionnaire (PAR-Q) is used. However, it is not available in Odia, a language spoken in Odisha, India. Aim and Objective: This study aimed to adapt the PAR-Q linguistically in Odia according to guidelines laid by the World Health Organization. Materials and Methods: The English questionnaire was forward translated from English to Odia by three bilingual experts and a consensus was reached to make a final Odia version. Then, the Odia version was back-translated to English by three language experts and a consensus was reached to form a final back-translated version. Then, the conceptual equivalence was checked between the two versions for finalizing the Odia version. Then, the questionnaire was pre-tested and cognitive interview was conducted. Results: We have successfully forward translated and back-translated the PAR-Q. The Odia version and back-translated English version showed an acceptable level of equivalence by two individual raters with an acceptable level of agreement. The Odia PAR-Q was successfully pre-tested. Conclusion: We have linguistically translated the PAR-Q in Odia. This questionnaire can be used for screening individuals for their fitness for enrolling and engaging in exercise. This questionnaire would help sports authorities as well as paramedical staff in screening Odia speaking subjects who are not comfortable with English.

Ayurvedic Management of Putraghani Yonivyapada (Recurrent Abortions): A Case Report

Recurrent miscarriages are characterized as three or more spontaneous abortions in a row before the 20th week. In the majority of instances, genetic factors, immunological and endocrine factors, infection, and unknown causes are the most common causes of first trimester abortion. Hormonal therapy, heparin injection, and immunotherapy are the available treatments. In this case study, the patient had three abortions during the first trimester. Because all of the tests came out normal, the diagnosis of unexplained recurrent abortions was made. For 40 days before conception, the patient was treated with Ayurvedic medications such as Indukanta Ghrita, Phalghrita. The patient was conceived with these drugs, and later Phalaghrita and other medicines were given for the duration of the pregnancy. Ayurvedic medicine is an effective way to deal with recurring abortions.

Role of Ki-67 and Argyrophilic Nucleolar Organiser Region (AgNoR) Counts in Squamous Cell Carcinoma

Background: Squamous cell carcinoma of the cervix is the most common subtype of cervical cancer and it usually accounts for 80-90% of the cases. These carcinomas mostly grow at the squamocolumnar junction (SCJ). The tumour tends to grow outward showing an exophytic growth especially at the squamocolumnar junction outside the external uterine wall whereas cancer tends to grow along the cervical canal showing an endophytic growth pattern where the SCJ is located within the cervical canal. This study has experimentally shown the role of AgNOR and Ki-67 scores in tumour proliferation. Methods: Cervical specimens were obtained and prepared in a specified fashion as described. The samples were de-waxed and staining was done with AgNOR. Then, the AgNOR was counted and scoring was done. Again, the samples were also stained with Ki-67. Results: This study has included 235 cases from the Department of Pathology of Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, India. The mean value of AgNOR count in the Control group came to be 10.62�45 while the mean AgNOR count was found to be 10.62�45, 15.10�79, 18.39�67, 19.75�74 and 19.59�59 for in-Situ SCC, well-differentiated SCC, moderately differentiated SCC, poorly differentiated SCC, SCC with basaloid differentiation, respectively. Conclusion: The study confirmed that AgNOR count increases with a higher grade of malignancy. It was concluded that AgNOR and Ki-67 scores can be used as an efficient predictor of tumour proliferation.

Beyond diabetes mellitus: role of metformin in non-muscle-invasive bladder cancer

INTRODUCTION@#Usage of metformin is associated with improved survival in lung, breast and prostate cancer, and metformin has been shown to inhibit cancer cell growth and proliferation in in vitro studies. Given the lack of clinical data on metformin use in patients with bladder cancer, we aimed to evaluate the role of metformin in their oncological outcomes.@*METHODS@#Medication use data from a prospectively maintained database of 122 patients with non-muscle-invasive bladder cancer treated with intravesical Bacille Calmette-Guerin (BCG), who were recruited under a randomised, double-blinded, controlled clinical trial, was collected and analysed. Kaplan-Meier curves were used to assess overall survival (OS) and disease-specific survival (DSS).@*RESULTS@#At a median follow-up duration of 102 (range 3-357) months, 53 (43.4%) patients experienced disease recurrence and 21 (17.2%) experienced disease progression. There was no significant difference in mortality between patients with and without diabetes mellitus. There was significant difference in OS between patients without diabetes mellitus, patients with diabetes mellitus on metformin and patients with diabetes mellitus but not on metformin (p = 0.033); patients with diabetes mellitus on metformin had the best prognosis. Metformin use was associated with significantly lower DSS (p = 0.042). Other oral hypoglycaemic agents, insulin or statins were not associated with disease recurrence or progression.@*CONCLUSION@#Metformin use was associated with improved oncological outcomes in patients with non-muscle-invasive bladder cancer treated with intravesical BCG. Prospective studies with larger patient populations are needed to validate the role of metformin as potential therapy for bladder cancer.

Review of stentless, tubeless, apposed renal (STAR) transplant wound management programme

INTRODUCTION@#We aimed to review the necessity of conventional interventions in renal transplant for preventing complications arising out of the use of wound drains, ureteral stents and stapled skin closures.@*METHODS@#We reviewed a series of 33 patients who received stentless, tubeless/drainless and suture-apposed living donor renal transplants (STAR group) and compared the results to a control non-STAR group of 36 patients in whom all three interventions of drains, stents and skin staples were used.@*RESULTS@#No significant differences in demographics and clinical characteristics were observed between the two groups. With regard to the overall surgical complications, no significant differences in terms of wound infection, seroma, perinephric collections, urinoma, bacteriuria or vascular complications were observed between the groups. When analysed according to the interventions specific for preventing complications, although slightly more asymptomatic perinephric collections were observed and two lymphoceles required treatment in the STAR group, these differences were not statistically significant. Similarly, no significant differences in ureteric or skin-related complications were observed between the groups. Both groups had comparable good outcomes for renal function, graft survival and patient survival.@*CONCLUSION@#The routine use of ureteric stents, drains or skin staples may not be necessary for uncomplicated renal transplants. Potential complications associated with the placement of these interventions can be avoided without compromising on the safety of patients and/or the outcome of transplants.

Insufflation of Carbon Dioxide versus Air During Colonoscopy Among Pediatric Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background/Aims@#Carbon dioxide is increasingly used in insufflation during colonoscopy in adult patients; however, air insufflation remains the primary practice among pediatric gastroenterologists. This systematic review and meta-analysis aims to evaluate insufflation using CO2 versus air in colonoscopies in pediatric patients. @*Methods@#Individualized search strategies were performed using MEDLINE, Cochrane Library, EMBASE, and LILACS databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane working methodology. Randomized control trials (RCTs) were selected for the present meta-analysis. Pooled proportions were calculated for outcomes including procedure time and abdominal pain immediately and 24 hours post-procedure. @*Results@#The initial search yielded 644 records, of which five RCTs with a total of 358 patients (CO2: n=178 versus air: n=180) were included in the final analysis. The procedure time was not different between the CO2 and air insufflation groups (mean difference, 10.84; 95% confidence interval [CI], -2.55 to 24.22; p=0.11). Abdominal pain immediately post-procedure was significantly lower in the CO2 group (risk difference, -0.15; 95% CI; -0.26 to -0.03; p=0.01) while abdominal pain at 24 hours post-procedure was similar (risk difference, -0.05; 95% CI; -0.11 to 0.01; p=0.11). @*Conclusions@#Based on this systematic review and meta-analysis of RCT data, CO2 insufflation reduced abdominal pain immediately following the procedure, while pain was similar at 24 hours post-procedure. These results suggest that CO2 is a preferred insufflation technique when performing colonoscopy in pediatric patients.

A rare occurrence of Premature Birth and Recurrent Acute Pulmonary Oedema in the mother due to Cushing’s Syndrome: A case report / Journal of the ASEAN Federation of Endocrine Societies

@#Presentation of Cushing’s syndrome during pregnancy is extremely rare. We report a 21-year-old female with Cushing’s syndrome diagnosed at 23 weeks of gestation and had recurrent acute pulmonary oedema during the antepartum and postpartum period. She delivered prematurely via emergency caesarean section at 28 weeks of gestation. This case highlights the rare occurrence of recurrent acute pulmonary oedema during pregnancy and consequential premature birth in a patient with adrenal Cushing’s. She was diagnosed with adrenal Cushing’s during the postpartum period based on unsuppressed serum cortisol after overnight and low-dose dexamethasone suppression test with a suppressed ACTH. CT scan of the adrenal glands revealed a right adrenal cortical adenoma. The risk of complications in infants and mothers who suffer from Cushing’s syndrome needs to be handled carefully. The diagnosis of Cushing’s syndrome in pregnant women often overlaps and is difficult to establish in early pregnancy.

Insufflation of Carbon Dioxide versus Air During Colonoscopy Among Pediatric Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background/Aims@#Carbon dioxide is increasingly used in insufflation during colonoscopy in adult patients; however, air insufflation remains the primary practice among pediatric gastroenterologists. This systematic review and meta-analysis aims to evaluate insufflation using CO2 versus air in colonoscopies in pediatric patients. @*Methods@#Individualized search strategies were performed using MEDLINE, Cochrane Library, EMBASE, and LILACS databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane working methodology. Randomized control trials (RCTs) were selected for the present meta-analysis. Pooled proportions were calculated for outcomes including procedure time and abdominal pain immediately and 24 hours post-procedure. @*Results@#The initial search yielded 644 records, of which five RCTs with a total of 358 patients (CO2: n=178 versus air: n=180) were included in the final analysis. The procedure time was not different between the CO2 and air insufflation groups (mean difference, 10.84; 95% confidence interval [CI], -2.55 to 24.22; p=0.11). Abdominal pain immediately post-procedure was significantly lower in the CO2 group (risk difference, -0.15; 95% CI; -0.26 to -0.03; p=0.01) while abdominal pain at 24 hours post-procedure was similar (risk difference, -0.05; 95% CI; -0.11 to 0.01; p=0.11). @*Conclusions@#Based on this systematic review and meta-analysis of RCT data, CO2 insufflation reduced abdominal pain immediately following the procedure, while pain was similar at 24 hours post-procedure. These results suggest that CO2 is a preferred insufflation technique when performing colonoscopy in pediatric patients.

Vitamin B12 - Do You Know Everything?

The term Vitamin B12 is used as a generic descriptor for the cobalamins; cobalt containing compound possessing the corrin ring having the biological activity of vitamin. The active coenzyme forms of vitamin B12 are methylcobalamin and deoxyadenosylcobalamin. Dietary sources of vitamin B12 are of animal origin and include meat, eggs, milk, dairy products, fish and poultry. Vitamin B12 is absent in plant foods and humans obtain small amount of vitamin B12 from their intestinal flora. Vitamin B12 plays a crucial role in DNA synthesis, nucleoprotein, erythropoiesis, myelin synthesis, normal growth and cell reproduction and one carbon metabolism. Vitamin B12 deficiency may arise due to decreased dietary intake. Vitamin B12 helps in isomerization of methylmalonyl-CoA to succinyl-CoA by methylmalonyl-CoA mutase and also helps in conversion of homocysteine to methionine by methionine synthase. Dietary deficiency is seen in strict vegetarians, since vitamin found only in foods of animal origin or in microorganism. Deficiency of Vitamin B12 causes pernicious anaemia, megaloblastic anaemia, methylmalonic aciduria, Neuropathy and folate trap. The present review concludes that vitamin B12 deficiency affects a person’s mental and physical health and it can cause severe, irreversible neurologic damage, disorientation, nerve damage, insomnia and many other diseases as mentioned in article. Adults should take 2.4 mcg of vitamin B12, deficiency is mainly seen commonly in Vegetarian they have to add vegan sources of vitamin B12 to their diet which include fortified cereals, bread, nutritional yeast and plant milks. Early identification of vitamin B12 status should be preliminary screening step to reverse the damage caused by vitamin B12 deficiency which will helps in prevention of diseases.

Histo-pathological pattern of endometrial biopsy in females with abnormal uterine bleeding: a retrospective study in tertiary care hospital of Haryana

Background: This study aimed to know the various histo-pathological patterns of endometrial biopsy and their incidence in patients of AUB.Methods: Patients in the age group between 21-75 years who had presented with AUB and underwent endometrial biopsy from 1st January 2017 to 31st December 2019 were included. The endometrial biopsy specimens which were already taken from patients with AUB were scrutinized for histopathological pattern. Various patterns of histo-pathology of endometrial biopsy were noted and studied.Results: Most common age group which was affected was between 36-40 years. The endometrial biopsies and curetting’s on histopathology revealed various patterns ranging from normal endometrium to malignancy. Patterns of normal cyclical endometrium (proliferative and secretory phases) were the most common patterns.Conclusions: Evaluation of women with AUB is important around the perimenopausal age group to detect any atypical and malignant changes and intervene early. Histopathological examination in correlation to radiological findings remain the standard procedures for diagnosis.

The Pandemic of 21st Century - COVID-19

The global pandemic of novel coronavirus disease is mainly caused by the infection of Coronavirus ‘SARS-CoV-2’. It is infecting persons of all ethnicity, race and community. Corona viruses are enveloped RNA viruses which range from 60 to 140 nm in diameter with spike like projections on their top. Coronavirus is affecting 199 countries, territories and international transport systems. Covid-19 is a recent pandemic, which started in Wuhan, China, at the end of 2019 and now it is affecting the whole world. WHO declared this outbreak as a pandemic on March 11, 2020. COVID-19 infection is transmitted by inhalation or contact with infected droplets or aerosols of infected persons, and the incubation period ranges from 5 to 14 days. Viral aerosols remain active for 3 hours in the air, 24 hours on cardboards, and 2 to 3 days on stainless steel and plastic. Symptoms are usually fever, cough, breathlessness, sore throat, malaise and fatigue. In some people, it may progress to pneumonia, multiple organ dysfunction, and acute respiratory distress syndrome. People with heart diseases, lung diseases, cancer, old age, diabetics, Immunosuppressed, and pregnant women are at higher risk for COVID-19 infection. To date, there are now more than 2,732,701 cases of COVID 19 globally with more than 191,150 deaths. In India, total cases are 23,502 with 722 deaths. First case of coronavirus was seen on 29 January 2020. On 24 March 2020, the government of India under Prime Minister Shri Narendra Modi ordered a nationwide lockdown for 21 days, after a 14-hour voluntary public curfew on 22nd March. India is one of the most populous countries of the world. India has the second largest population in the world. Due to the lack of vaccines, ventilators, targeted therapies, mass gatherings, the Indian government started lockdown, the largest exercise in the world with the second largest population. To reduce public movement, section 144 was implemented in many states. A full lockdown will help the collapse of the whole national health system

Urticaria Due to Adverse Drug Reaction in Diabetes - A Case Presentation

Type 2 diabetes mellitus (T2DM) is a chronic condition caused by the inability of pancreas to produce enough insulin. Insulin lowers the blood glucose and enables it to enter the cells. Urticaria also known as hives is a result of skin reaction when certain body cells release histamine. They are itchy and can appear in any part of the body. Metformin is the first line of treatment for type 2 diabetes mellitus for controlling high blood sugar by decreasing glucose production by the liver and by increasing insulin sensitivity of body tissues. India is at the top of the world with highest number of people with diabetes mellitus (31.7 million). WHO has predicted that by 2030 T2DM may affect up to 79.4 million individuals in India.1Diabetes mellitus is a group of metabolic disorder characterized by increased glucose productionand decreased glucose utilization and the complications arising from this disease are major causes of death worldwide. Cells of the body cannot metabolize carbohydrate due to relative or complete lack of insulin, and so the body breaks its own protein, fat and glycogen resulting in hyperglycemia.2,3 T2DM earlier referred to as non-insulin dependent diabetes or adult onset diabetes, accounts for 90 - 95 % of all diabetes.4 Metformin is an oral agent and is considered as insulin sensitizer because it helps in lowering insulin levels, reduces hepatic glucose production, improves peripheral glucose utilization, and helps in uptake and utilization of gut glucose.5Urticaria is caused by dermal oedema, secondary to temporary increase in capillary permeability resulting from increased release of histamine from the mast cells situated around the capillaries. Urticaria present for more than 6 weeks is considered to be acute and chronic.6

Role of Vitamins and Minerals in Improving Immunity during Covid-19 Pandemic - A Review.

The COVID-19 pandemic has brought attention to the role of the immune system. The immune system can be strengthened by diet, supplements and good hygiene practices. The immune system is comprised of different cells contained in the blood, lymph, and tissues that are distributed across the body. A large number of cells and even greater numbers of chemical messengers engage in the body's immune defence. In immune response blood cells, B-lymphocytes and T- lymphocytes play a vital role. The world health organization, urges people to follow a healthier lifestyle, saying it will increase their chances of a quick recovery. Proper nutrition is required for proper functioning of immune system. Therefore, healthy balanced diet is the best way to support the immune function. Vitamins and minerals are important ingredients of the diet that the body requires to work properly. Vit D is required in limited amounts to maintain good health. Vitamins and minerals together are also called micronutrients, as they are required in very small quantities. On the other hand, carbs, proteins and fats are altogether termed as macronutrients. In recent years, vitamins A, C, D, and E, believed to have an effect on the immune system, have gained significant attention because they are involved in enhancement of immune systems. Solely, vit-A is involved in proper functioning of eye, immune system and also takes care of skin and genes. In green leafy vegetables, carrots, pumpkin, melons and mangoes vitamins are present in form of pre-vitamins, and further converted into active vit A inside the human body. It is surprising that liver, yolk of egg, butter, whole milk, and cheese are active source of vitamin A. Having a healthy diet including lots of fruits, vegetables is a key component of healthy lifestyles and plays a crucial role in maintaining a properly functioning and efficient immune system to defend against infections and other diseases. All the data was assessed from online search (PubMed, Google Scholar). In this review article we concentrate on vitamins and minerals.

Implementation of meta-analysis approach, comparing conventional radiotherapy, and proton beam therapy treating head and neck cancer

Introduction: Radiation therapy is commonly used in the treatment of head and neck cancer in both the definitive and postoperative settings. Proton therapy, due to its intrinsic physical properties, has the ability to reduce the integral dose delivered to the patients while maintaining highly conformal target coverage Materials and Methods:.A literature search was performed on scientific databases, and Preferred Reporting Items for Meta-Analyses guidelines were followed to compute results. Only original studies were selected. Selected studies were used to extract some proposed data for comparison, dosimetry, site, complications, and survival. Results: Proton beam therapy technology can be used against the conventional radiotherapy and shows satisfactory results. Yet conventional therapy is not less advantageous considering the amount of work available for any cross interpretations. Conclusion: Comparative preplanning could be beneficial considering multiple therapies for ruling out the best treatment outcomes that could be expected