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The World Health Organization (WHO) declared the outbreak of COVID-19 as a Public Health Emergency of International Concern on January 30, 2020. Due to the sudden incidence and high pathogenicity, there is little knowledge about the risk of infection by the virus to pregnant women and parturient. The issues pertaining to transplacental transfer and also there is lack of clarity on potential complications of SARS-CoV-2 coagulopathy.The report about the influence of COVID-19 on pregnant women and their babies is very limited . Moreover, it is not clear the effects covid infected mothers (anytime in the 2nd or 3rd trimester of the gestational period) will have on the physiological status of the infants who themselves have not been infected by Covid-19. This study has been designed to assess any difference or deviation in the biochemical parameters of a COVID negative infant of a COVID infected mother during any time of her pregnancy from the values usually observed from the study of biochemical parameters of a neonate born of non-COVID infected mother based on history taking and checking of reports for RTPCR and Rapid Antigens Test for COVID 19. At the initial level the study population was distributed into two groups of 50 mothers each, 1st group consisted of mothers infected by COVID 19 and 2nd group consisted of mothers not infected by COVID 19 during pregnancy. The neonatal biochemical parameters were evaluated based on the data gathered from cord blood sample analyses. The primary objective for conducting this study will be to estimate the incidence of any altered amount of D-dimer, Procalcitonin, CRP, ALT, AST, ALP, Direct bilirubin, Indirect Bilirubin, PT/INR in non-covid infants born of covid mothers versus non-covid infants born of non-covid mothers. This study found that the neonates who were COVID negative despite having COVID infected mothers did not have any stark variation in the values of biochemical parameters as compared to the control neonates of this study group. However, since COVID is a relatively new disease with little knowledge about its consequences the maternal COVID status may have an impact on neonatal health in the long run. So, as far as possible the regular periodic health check up and screening of the aforementioned biochemical parameters of these neonates should be followed consistently
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The clinical spectrum of SARS CoV 2 infection appears to be wide, encompassing asymptomatic infection, mild upper respiratory tract illness, and severe viral pneumonia with respiratory failure and even death, with many patients being hospitalized with pneumonia This study was a hospital based, cross sectional, observational, non interventional study. This study took place in Medical College and Hospital , Kolkata , study duration was from May 2020 – July 2022 .One-hundred and three patients diagnosed with COVID-19 infection as tested by real-time quantitative PCR (RT-qPCR) test were included. Those presenting with fever and/or respiratory symptoms and chest x-ray findings suggestive of lung infection were diagnosed as having COVID-19 pneumonia (n = 69). Those identified to be positive for RT-qPCR test but did not have any symptoms were considered asymptomatic (n = 34). The results showed that the mean of the serum level of IL6 ,CRP, ferritin, LDH, and D Dimer was higher significantly (P ? 0.000) in COVID19 patients compared to the healthy control group . The mean of theses parameters is significantly increased in patients with severe coronavirus infection and reached (28.63 ± 14.67 pg/ml,471.60 ± 202.92 pg/ml and 443.55 ± 99.38 IU/L) for IL 6, ferritin, and Lactate Dehydrogenase(LDH) respectively, while in patients with simple to moderate infection, the levels of IL6, ferritin, CRP, and LDH is reached (9.56 ± 0.66 pg/ml, 232.14 ± 161.29 g/ml, 25.64 ± 22.53 mg/ml, and 335.80 ± 97.63 IU/L) respectively. We also found that total lymphocyte count was decreased significantly (P = 0.018) in patients infected with SARS CoV2 (mean = 13.66 ± 4.29), in contrast, neutrophils count was increased significantly (P ? 0.000) in patients (90.43 ± 12.40) compared with healthy subjects (51.63 ± 5.66). Though for more detailed research a study with much more larger sample size,and study design like prospective cohort should be taken for better understanding of the altered levels of those parameters over the morbidity and mortality of covid 19 positive patients
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An estimated 87% of pregnant women in India suffers from iron de?ciency anemia in some point in their pregnancy. Maternal anemia has been found to be associated with low birth weight babies, asphyxia, preterm delivery and neurological de?cits & the neonatal iron stores are solely dependent on the transplacental iron transport, about 1gm in term newborns. The transfer of iron from the mother to the foetus is tightly regulated by factors such as transferrin, coelomic ?uid and hepcidin. This study aims to ?nd whether maternal anemia has a correlation with neonatal anemia. Also, it aims to screen for neonatal anemia based on cord blood evaluation.The parameters used for comparison from cord blood are serum iron, ferritin and total iron binding capacity (TIBC) and blood hemoglobin concentration. This study was conducted over a period of two months, from July 22 nd 2021 to September 21 , 2021, in Medical College & Hospital , Kolkata and a total of 124 mother-infant pairs were taken out of which 62 were anemic mothers (Hb<11g/dl) and 62 non anemic. The cord Hb, iron and ferritin levels were signi?cantly (p<0.05) lower in the anemic mothers than in the non anemic ones. The cord TIBC in the anemic group was higher but it was not signi?cant (p=0.083). There was a moderate positive correlation between mother's Hb and cord iron levels, r= 0.46, p< 0.00001, a slight negative correlation between mother's Hb and cord TIBC was observed but the values were not signi?cant, r= -0.13, p=0.31, serum ferritin in cord blood was found to have moderate positive correlation with maternal Hb, r= 0.40, p < 0.00001. This study was able to establish a correlation between maternal Hb and cord Hb, iron and ferritin thus showing that maternal iron status affects the iron pro?le of the neonate. This emphasises the need for proper iron and folic acid supplementation during the course of the pregnancy.
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Globally, the prevalence of chronic coronary syndrome (CCS) increases with age. In India, there is a rapidly growing burden of coronary artery disease (CAD), which has become the leading cause of morbidity and mortality. Despite recommended medical therapy, patients with CCS are still at risk of ischemic events. Currently, dual antiplatelet therapy (DAPT) is recommended in the form of aspirin and a P2Y12 inhibitor or low dose rivaroxaban in patients with stable CAD and/or peripheral artery disease (PAD). A low dose of rivaroxaban in combination with aspirin is a promising approach; however, for patients who might benefit the most, it still remains a challenge. Clinical trial data on this new drug was certainly very encouraging, with evidence from the COMPASS trial and prespecified subgroups of COMPASS trials suggesting that the addition of rivaroxaban to aspirin was associated with a significantly lower risk of ischemic events, mortality, and tolerable bleeding profile in patients with CCS and high-risk factors. This combination is cost-effective and generally well tolerated in patients with CAD and/or PAD, as well as patients with CCS and multimorbidity or high-risk populations.
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Introduction: Stroke is one of the leading causes of death and disability in India. Stroke survivors may suffer from lifelong physical and cognitive frailty. There is a need for more studies on the prevalence and determinants of this debilitating disease at the national level. Thus, assessing the factors associated with stroke is vital to developing appropriate preventive strategies in India. Methods: Data from the Longitudinal Aging Study in India wave 1 (2017–2018) are utilized for this analysis. The survey collected demographics, social, economic, and health data, including lifestyle factors and stroke, from 65,900 older adults ?45 years representing all states and union territories. Stroke prevalence was calculated for each independent variable, and the differences were compared using the ?2 test. An unconditional multivariable logistic regression model was used to obtain the adjusted odds ratios (AOR) and 95% confidence intervals (CIs) of each lifestyle and socioeconomic variable for stroke prevalence. Results: The prevalence of self?reported stroke was 1.71% (95% CI: 1.61–1.80). Older adults with hypertension (AOR=3.69, 95% CI: 2.95–4.62), family history of stroke (AOR=3.09; 95% CI: 2.33–4.12), arrhythmias (AOR=2.27; 95% CI: 1.20–4.29), physical inactivity (AOR=1.91; 95% CI: 1.55–2.34) were strong contributors of stroke. Diabetes and high cholesterol individuals have 1.5 times more odds for stroke than those without those conditions. Increasing age (AOR=1.57 for 55–69 older adults, and AOR 2.05 for ?70 years), male sex (AOR=1.75; 95% CI 1.36–2.26), and rich (AOR=1.58; 95% CI: 1.21–2.06) were also associated with increased odds for stroke. Conclusion: The prevalence of stroke was high among adults aged ?45 years in India. Hypertension, family history of stroke, arrhythmias, and low physical activity were significant contributors to stroke. The findings suggest that preventing and controlling these lifestyle conditions and behaviors may help prevent stroke.
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Background: With so much burden of advanced incurable disease, the role of palliative surgery is paramount for gastrointestinal malignancies improving quality of life. Aim of the study was to study the indications, risks and outcome of palliative surgeries in gastrointestinal malignancies, the burden of disease requiring palliative surgery, and to describe strategies to improve end of life care.Methods: All the patients diagnosed with gastrointestinal malignancy and who underwent palliative surgery between January 2017 and December 2017 were analysed.Results: A total of 186 cases underwent palliative surgery. The most common age group affected was between 50-60 years and the mean age was 54.55 years. Stomach was the most common primary consisting of 58.60% followed by colorectal (23.66%), small intestine (9.68%), hepato-pacreatico-billiary (4.30%), and oesophageal (3.76%) primary. Major complications were seen in 4.84% of cases. Average symptomatic relief was observed for 5.5 months in cases of stomach and 7 months in case of colorectal malignancies. 35.48% cases were alive at the end of one year.Conclusions: Present study concludes that palliative surgery improves quality of life of the patient, provides them with time to accept death and live rest of the life in a dignified manner.
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Background: Anti-depressant drugs have great benefit in treating a many psychiatric disorders, including schizophrenia and bipolar disorder, although all these drugs are associated with many potential adverse effects. In this study, the occurrence of adverse effects like weight gain, sleep disturbances, dry mouth were assessed and reported in drug naïve patients Anti-depressant drugs.Methods: It is a prospective observational study of patients attending Psychiatry department in NRI General Hospital of age 10 to 80 years who were prescribed with anti-depressant drugs. The study was conducted for a period of 8 months from June 2018 to February 2018.Results: Among 86 patients prescribed with antidepressants, the occurrence of adverse drug reactions due to antidepressants was 60.78% with Selective serotonin reuptake inhibitors being the most common class of drugs implicated for adverse drug reactions followed by 24.49% with Tricyclic antidepressants. A total of 51 adverse drug reactions were noted of which weight gain was most common, closely followed by sleep disturbances and drowsiness. Out of 52 adverse drug reactions assessed for causality, 88.2% of the adverse drug reactions cases were probable, while 11.7% were possible. According to Hartwig and Siegel’s Scale 84.3% of the cases are found to be mild, 15.68% moderate.Conclusions: The study allows knowing information about the occurrence and pattern of adverse drug reactions associated with Anti-depressant drugs in the population thus reducing its incidence and protecting the user population from available harm.
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Black pepper (Piper nigrum L.), referred as the ‘King of Spices’, is native to India and has shown declined productivity over the years. It exhibits diverse quantitative and qualitative traits, particularly in spike length, floral composition, floral arrangement, fruit size and number. The novel mutant variety of black pepper (Piper nigrum L.) ‘Thekken’ shows a remarkable branching character in the spikes. In the present study, we analyzed RAMOSA3 (RA3) gene at the molecular level in this variety for yield improvement. Screening using degenerate primers designed for RA3 was carried out in ‘Thekken’ and a non-branching variety ‘Karimunda’ at the genomic level and at different stages of spike development at the transcriptome level. Sequence analysis of the amplicons generated in RT-PCR revealed the presence of an integrase core domain in the mutant type of black pepper, suggesting a possibility of mutation at this locus in the branched variety due to retrotransposon integration. The study suggests a possibility for introgression of the genes responsible for branching trait from the mutant variety of black pepper type ‘Thekken’ to other conventional cultivated varieties of black pepper that show single unbranched spike thereby increasing the productivity of black pepper which has very high economic value and export potential.
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Nine year old girl was presented with paroxysmal episodes of hypertensive emergency. She was asymptomatic with normal blood pressure without antihypertensives in between the episodes. MRI brain was suggestive of reversible posterior leukoencephalopathy.' Acute episodes were managed with IV labetalol infusion and amlodipine. She was evaluated extensively to find out the etiology of hypertension. Cardiac and renal causes were ruled out. Work up for pheochromocytoma, hyperaldosteronism, porphyria and vasculitis were negative. The case is reported in view of the rare presentation and the leukoencephalopathy noted in this case.
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Purpose: The gold standard for evaluating Retinopathy of prematurity (ROP), a potentially blinding disease in preterm babies, is by indirect ophthalmoscopy which is quite subjective. Digital imaging with RetCam, an advanced wide field imaging system is more precise but it is not easily available or affordable. Smartphones are being explored as an alternate cost effective and accessible imaging tool. This is possible because of the good illumination and the built-in high resolution cameras available in modern smartphones. The aim of this study is to illustrate the utility of MII RetCam assisted smartphone based fundus imaging (MSFI) in the documentation and monitoring of ROP. Methods: Single-centre, retrospective observational study of all the preterm babies subjected to MSFI as part of ROP screening from September 2017 to November 2018. iPhone 4S and + 20 Diopter lens attached to the MII RetCam device was used for fundus imaging at baseline and during follow up. The statistical analysis used for the same is the SPSS statistical software. Results: Good quality images of central and peripheral retina could be captured in 33 out of 42 babies (78.57%) with ROP. Serial imaging done in 24 babies with ROP helped in precise monitoring of the disease and planning management. Incidentally detected non-ROP findings were also documented. Unique design of the device enabled imaging by a single examiner. Image database created was useful for academic and counselling purposes. Smaller field images which can cause difficulty in distinguishing the zones is a limitation. Conclusion: MSFI is a potential alternate imaging tool enabling objective documentation and monitoring of ROP in low resource settings.
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Aim: To assess the utility of frozen section in this recent scenario of improved patient care Methods: In our study we analysed the efficacy of frozen section in 135 cases over a period of one and half years including thyroid, ovary, east, parotid,lymph node, margin assessment in colon malignancy by comparing it with histopathology, considering the latter as gold standard. Results:We found the overall accuracy of frozen section to be 85.37% with a sensitivity of 85.3% and soecificity of 84.6% in thyroid cases. In case of ovarian tumours frozen section had 90.91%sensitivity and 97.96% specificity for malignant tumours. Conclusion:Understanding the limitations, frozen section can be used as a reliable intraoperative tool.
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Background: There are currently two different guidelines for treatment of Vitamin D deficiency in infants, one is that of American Academy of Pediatrics and the other being Clinical Practice Guidelines of the Endocrine Society. This study was done to compare the two guidelines for treatment of Vitamin D deficiency in infants.Methods: A hospital based, longitudinal interventional study was conducted for 2 years and 115 babies having vitamin d deficiency (Vitamin D less than or equal to 20ng/dl) were divided into group A and group B. Group A babies were treated as per American Academy of Pediatrics Guidelines whereas Group Cases were treated as per International Endocrine Society guidelines. All babies were followed up after 3-4 months when repeat Vitamin D levels were checked and then compared.Results: In present study, Vitamin D level had increased by 0.6 times in Group A whereas it had increased by 1.3 times in group B and it was significant.Conclusions: Study results were in favour of the guidelines recommended by the International Endocrine Society.
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Background: Oral cavity has various pathogens and most of the denture wearers are older individuals with impaired ability to clean denture and there are conditions where prescription of adhesive is must, which in turn can act as biofilm for growth of Candida. As there are contradictory review on use of adhesive there is a need to study the affect of denture adhesive on candidal growth. Methods: In this randomised clinical trial 24 healthy individuals were randomly recruited. These 24 were divided into 2 groups of 12 individuals each. Group 1 subjects were given powder form of adhesive and group 2 subjects were given paste form of adhesive. Baseline sample (swab) was taken from palate and saliva. After 15 days of use of adhesive, three samples (swab) were taken from palate, saliva and tissue surface of denture. These samples were further subjected to microbiological analysis. Results: Both the groups showed significant increase in candidal growth. Conclusion: This study advocates that denture adhesive do promote the growth of Candida. This could also be due to impaired manual dexterity of the individual or improper hygiene.
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Human immunodeficiency virus disease (HIV) and sexually transmitted viral infections (STIs) are important cause of increasing morbidity and mortality in sexually active individuals, In our study we the incidence, age, sex distribution, risk factors and prevalence of viral STIs among HIV positive and negative patients who attended the tertiary care hospital and study we found that Herpes Genitalis to be the most common viral infection in HIV seropositive patients. Condylomaaccuminata are second most common viral infection in seropositive HIV patients. Social factors, lack of awareness, multiple sexual partners, poverty also contributed to the spread of HIV. HPV vaccine-based prevention and education programs need to be implemented in this high-risk community and centres providing voluntary counselling and testing (VCT) services for HIV. Introduction Human immunodeficiency virus (HIV) disease and sexually transmitted viral infections (STIs) are important cause of increasing morbidity and mortality in sexually active individuals. Patients suffering with viral STI are more vulnerable to acquire HIV infection in comparison with individuals without STI. HIV-seropositive patients are more vulnerable to acquire viral STI in comparison with HIVseronegative patients. Objectives of the Study To study the incidence, age, sex distribution, risk factors and prevalence of viral STI among HIV-positive and negative patients who attended the tertiary-care hospital. Materials and Methods This is a prospective and descriptive study conducted in STI clinic, Andhra Medical College, Department of Dermatology Venereology and Leprosy, King George Hospital, Visakhapatnam, Andhra Pradesh, for a period of 1 year from February 2017 to January 2018. The study includes 150 HIV-seropositive patients suffering with viral STI like genital herpes, molluscum contagiosum, genital warts, viral hepatitis and 150 HIV-seronegative patients. Results In our observation of 150 HIV-seropositive patients, herpes genitalis 57 cases (38%) was found to be the most common viral STI followed by condyloma accuminata 34 cases (22.7%). The most common age group involved was 20–29 years 68 cases (45.4%) with males most commonly effected 108 (72%) than females 42 (28%). Social factors like illiteracy, multiple sex partners and unprotected sex contributed to the risk of viral STI and HIV. Conclusion In our study, we found that herpes genitalis to be the most common viral infection in HIV-seropositive patients. Warts are second most common viral infection in seropositive HIV patients. Social factors, lack of awareness, multiple sexual practises, poverty also contribute to the spread of HIV.
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Objectives: This study sought to report 22 years experience in pediatric kidney transplantation in Oman
Methods: Electronic charts of all Omani children below 13 years of age who received a kidney transplant from January 1994 to December 2015 were reviewed. Data collected included patient demographics, etiology of end-stage kidney disease, modality and duration of dialysis, donor type, complication of kidney transplantation [including surgical complications, infections, graft rejection] graft and patient survival, and duration of follow-up
Results: During the study period transplantation from 27 living related donors [LRDs], 42 living unrelated donors [LURDs], also referred to as commercial transplant, and one deceased donor were performed. The median age at transplantation was nine years for both groups. The most common primary diagnosis was congenital anomalies of the kidney and urinary tract in 32.8% of patients followed by familial nephrotic syndrome in 20.0% and polycystic kidney disease in 18.5%. Almost half the patients were on hemodialysis before transplantation, 35.7% were on peritoneal dialysis, and 14.2% received preemptive renal transplantation. Children who received LURD kidneys had high surgical complications [42.8%] compared to the LRDs group [17.8%]. Five patients from LURDs group had early graft nephrectomy and four patients developed non-graft function or delayed graft function. In addition, patients in the LURDs group had a higher incidence of hypertension and acute rejection. Graft and patient survival were both better in the LRDs than the LURDs group
Conclusions: Although our pediatric kidney transplant program is a young program it has had successful patient outcomes comparable to international programs. Our study provides evidence that in addition to legal and ethical issues with commercial transplant, it also carries significantly higher morbidity and reduced graft and patient survival
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Breast carcinoma is the most common malignancy among South Indian women. Hormone receptor evaluation has become crucial for management of breast cancer. Very few studies have correlated oestrogen receptors (ERs) and progesterone receptors (PRs) with histologic parameters in Andhra Pradesh state of Southern India; therefore, the study was undertaken, and it is also to study the importance of immunohistochemistry (IHC) evaluation of ER and PR status and to evaluate and conclude the importance of modified Bloom-Richardson (MBR) grading in a routine investigation for prognosis and prediction of clinical outcomes. Aims and Objective (1) To evaluate the expression of hormone receptors in breast carcinoma and (2) to correlate their expression with other histological variables. Materials and Methods A prospective study was conducted for 2 years, at a tertiary care hospital in Vijayawada, Andhra Pradesh, India. In our study, 100 consecutive cases were included, which were reported by MBR system and evaluated for ER & PR receptor expression by Allred score. Statistical analysis was done by SPSS software, Student t-test and chi-square test. Results Majority of the age group affected was below 50 years, and mean age of the study population was 46.25 years. The most common histological variant was infiltrating duct cell carcinoma (91%), and predominant histological grade was MBR grade II (47%). ER and PR positivity were noted in 56% and 53% of cases, respectively. The common phenotypic expressions were ER+ PR+ (46%) & ER-PR-(37%). ER positivity was observed in 25% of grade I, 54.54% of grade II and 20.46% of grade III lesions (p = 0.005), and expression of PR was seen in 25.53% of grade I, 51.06% of grade II and 23.54% of grade III lesions (p = 0.001). ER+ PR+ phenotypic expression was positively correlated with low histologic grade, whereas ER-PR-correlated with high histological grade (p = 0.003). ER+ PR+ also correlated with lymphatic spread (p = 0.046) and vascular invasion (p = 0.011). However, no correlation was observed with age, tumour size and ER & PR expression (p > 0.05). Conclusion High nuclear pleomorphism, low tubule formation, high mitotic score & lymphovascular invasion were found more common in ER-PR-group than in ER+ & PR+ group with significant statistical correlation. ER & PR expression showed statistically significant correlation with MBR system and other pathological parameters. Hence, MBR grading should be incorporated as a routine investigation for prognosis and prediction of clinical ou Breast carcinoma (CA), Oestrogen receptor (ER), Immunohistochemistry (IHC), Invasive ductal carcinoma (IDC), Modified Bloom-Richardson grading (MBR), Progesterone receptor (PR) nuclear pleomorphism.
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Non-Hodgkin lymphoma (NHL) is an adverse group of neoplasms that can occur at nodal and extranodal sites with varied prognosis. NHL involving soft tissue as a primary site accounts to 0.1% of cases and may mimic sarcoma; therefore, it is necessary to differentiate them as described by travis and co-authors, similarly. We describe a case of 72-year-old male patient with a mass in the right thigh. Magnetic resonance image reported a benign soft tissue tumour; fine-needle aspiration cytology suggested a soft tissue sarcoma and computed tomography imaging reported no other sites of involvement. PET (Positron emission tomography) scan done after first cycle of chemotherapy revealed enlarged right-side femoral and external iliac group of lymph nodes. On histological examination and immunohistochemistry, it was diagnosed as primary diffuse large B-cell lymphoma involving skeletal muscle. The case is presented to highlight the diagnostic difficulties due to its presentation on a rare site.
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Background. The Medical Council of India (MCI) recommendations on medical education suggest a shift from didactic lectures to more interactive lectures. This study assessed the effectiveness of different pedagogical methods in biochemistry and the perceptions of students and teachers about the shift from didactic to interactive lectures. Methods. An interventional crossover study was done with the topic divided into three biochemical modules and one clinical module. The students were divided into two batches, one of which was given didactic and the other, interactive lectures. They were assessed immediately after the lecture and four months later. Anonymous feedback was obtained to gauge the students’ perceptions regarding the mode of teaching. The teachers’ feedback on the use of both pedagogical styles was also obtained. Results. There was no significant difference between the performance of the two groups in either examination in three of the modules. However, there was a statistically significant difference between the two groups’ performance in the module that had clinical applications, with students from the interactive lecture group performing better. All students preferred interactive classes, irrespective of the topic taught. The teachers indicated that, although at the outset the interactive lectures were difficult to manage, both in terms of content and time, these drawbacks could be overcome with time and practice. Conclusion. Interactive lectures are an effective teaching method in biochemistry, especially in topics involving clinical application. Natl Med J India 2016;29:222–4