COARCTATION OF AORTA IN A 33 YEARS-OLD UNCONTROLLED HYPERTENSIVE FEMALE PATIENT – A CASE REPORT

We report a 33-year-female patient of hypertension detected at the age of 19 year. Her blood pressure was not well controlled. The case was investigated for secondary hypertension. CT Thoracic and Abdominal aorta Angiogram of the present case showing the narrowing in the thoracic aorta extending at the level of T8 to T10 vertebral body level for the length of 7.5cm. Reconstructed CT of the case showed multiple tortuous collaterals between the branches of internal mammary artery and external iliac artery and between axillary and intercostal artery. Relevant history was reviewed and discussed.

Video consultations from an Indian academic hospital: First 3 years of experience from telepsychiatric after-care clinic

BACKGROUND Continuity of care for psychiatric disorders by conventional in-person consultation by psychiatrists is associated with several challenges. There is a need to develop alternative models of specialist care. We studied our 3 years’ experience of live video consultations (VCs) from the tele after-care clinic to patients with psychiatric disorders at an Indian academic hospital. METHODS We did a file review of 669 VCs provided to 213 patients in the first 3 years (2017–2019) from the telemedicine centre of a tertiary care academic hospital. We analysed details of sociodemography, clinical profile, tele after-care consultations and outcome. RESULTS Two hundred and thirteen patients (55% men) were enrolled for the tele after-care clinic. The mean (SD) age of the patients was 42.2 (17.29) years and a majority were educated till high school and beyond. Patients with severe and common mental disorders constituted 60.1% and 40%, respectively. Among the total 669 appointments, 542 (81%) VCs were successfully provided; of the remaining, 125 were cancelled and 2 were aborted due to a medical emergency. Medication prescriptions were unchanged in 499 and modified/totally changed in 47 VCs. CONCLUSION Our large study shows that telepsychiatric after-care is a useful alternative method which can supplement in-person follow-up. Barriers such as distance, cost and medical illness can be overcome using tele after-care clinics for regular follow-ups in stabilized psychiatric patients. There is a need for prospective studies, preferably, randomized controlled trials comparing effectiveness of tele after-care with in-person consultations to assess treatment outcomes.

A study to find the characteristic imaging findings of various ring-enhancing lesions using MR imaging

Introduction: Multiple ring-enhancing lesions are one of the most commonly encountered neuroimaging abnormalities. A study was conducted to find the characteristic imaging findings of various ring-enhancing lesions on MRI. Materials and methods: It was a prospective study conducted in the department of radiodiagnosis, GSL Medical College. All age groups of both gender with cerebral ring-enhancing lesions detected in contrast MR studies were taken up for spectroscopy. Patients with a history of claustrophobia and individuals with metallic implants insertion, cardiac pacemakers, and metallic foreign body in situ were excluded. The MRI scan was performed MRI PHILIPS ACHIEVA HDxt 1.5 T, the active shielded superconducting magnet of 1.5telsa magnetic field using SENSE coils for the acquisition of images. Results: Out of 30 study participants, under <45 years category tuberculoma was the common (37%) lesion whereas in >45 years category metastases was common (15%), 44% were female and 56% were males. Depicts T1 signal intensity showed hypointense signal intensity on T1W sequence in 65 (95.5%) cases. Only 4.6% of cases showed isointense signal intensity on T1W image. T2 signal intensity in 73.5% of cases showed hyperintense signal intensity. Conclusions: MRI is an excellent, non-ionizing imaging modality with multiplanar imaging capabilities for excellent grey-white matter differentiation

Antidiabetic effect of Pterocarpus marsupium seed extract in gabapentin induced diabetic rats

Background: Type 2 diabetes mellitus is the most common type of diabetes. Diabetes mellitus is a leading cause of morbidity and mortality among Indian population and all over the world with more than hundreds of millions of patients worldwide. Pterocarpus marsupium is a medicinal plant used in Ayurvedic system of medicine to control blood sugar and strong antidiabetic. The purpose of this study was to assess the hypoglycemic effect of the ethanolic extract of Pterocarpus marsupium seeds in diabetic rats.Methods: The present work was designed to evaluate the anti-hyperglycaemic activity of Pterocarpus marsupium seed extract (100 mg/kg and 200 mg/kg) on gabapentin induced hyperglycaemia in wistar albino rats. Blood glucose level, serum triglycerides, total cholesterol, HDL cholesterol and LDL cholesterol were evaluated in gabapentin induced diabetic rats. The results of the test drug were compared with the standard drug.Results: Ethanolic seed extract of Pterocarpus marsupium at 100 mg/kg and 200 mg/kg had significantly reduced the blood glucose level compared to disease control rats on day 1, 7, 14 and 21. Pterocarpus marsupium shows significant decrease in triglycerides levels, serum cholesterol levels, LDL levels and increased HDL levels, total protein levels compared to the disease control group.Conclusions: In conclusion, the present study shows that the ethanolic seed extract of Pterocarpus marsupium has potential antidiabetic action in gabapentin induced diabetic rats and the effect was found to be more similar to the standard drug metformin.

A Study Of Nutrient Foramina Of Dry Humerus In South Indian Population

Background: Nutrient foramen is an opening in the bone shaft which allows passage to the blood vessels of themedullary cavity of a bone for its nourishment and growth. Knowledge about precise location and direction ofthe nutrient artery of long bones is important during any surgical or orthopaedic procedures of limbs, such asbone grafts and microsurgical vascular bone transplantations. This study was carried to record the number,situation and position of nutrient foramina in humerus of adults in south Indian population.Materials and methods: The study was conducted on 85(Right-38, Left-47) humerii collected from AnatomyDepartment of Coimbatore Medical College, Coimbatore. Length of each humerus bone was measured with thehelp of osteometric board. With the help of hand lens bones were observed for the number, direction andlocation of nutrient foramen with respect to the surface and borders.Results: In the present study majority of humerus bones have single nutrient foramen(64.7%) and mainly locatedon the anteromedial surface(51.7%) followed by medial border (36.5%) especially in the middle one third (87.1%)of the humerus.Conclusion: This study may give precise knowledge about location and number of nutrient foramina which isimportant for orthopaedic surgeons during surgical procedures such as fracture repair, bone grafts andmicrosurgeries.

Mechanistic role of perfusion culture on bone regeneration

Bone tissue engineering (BTE) aims to develop engineered bone tissue to substitute conventional bone grafts. To achievethis, culturing the cells on the biocompatible three-dimensional (3D) scaffold is one alternative approach. The newfunctional bone tissue regeneration could be feasible by the synergetic combinations of cells, biomaterials and bioreactors.Although the field of biomaterial design/development for BTE applications attained reasonable success, development ofsuitable bioreactor remains still a major challenge. Tissue engineering bioreactors provide the microenvironment requiredfor neo-tissue regeneration, and also can be used to study the physio-chemical cues effect on cell proliferation anddifferentiation in order to produce functional tissue. In this direction, various bioreactors have been developed andevaluated for the successful development of engineered bone tissue. Continues assessment of tissue development andlimitations of the bioreactors lead to the progression of perfusion flow bioreactor system. Improvements in perfusion reactorsystem were able to yield multiple tissue engineered constructs with uniform cell distribution, easy to operate protocols andalso effectively handled for the functional tissue development to meet the adequate supply of engineered graft for clinicalapplication.

Microbiological and Clinical Characteristics of Klebsiella Pneumoniae Infection in Hyderabad, South India

Introduction: A new hypervirulent (hypermucoviscous)variant of Klebsiella pneumoniae has emerged. First describedin the Asian Pacific Rim, it now increasingly recognizedin Western countries. The dispute in the prevalence ofK. pneumoniae with these hypervirulent characteristicsbetween the infection and colonization condition are not wellunderstood. The objective of this study was to contrast theclinico-microbiological characteristics of K. pneumoniaeisolated from different samples.Material and methods: This retrospective study wasconducted at Department of Medicine, Osmania GeneralHospital, Hyderabad — a multi-speciality tertiary-careteaching hospital in Hyderabad, South India for the period ofSeptember 2016 to October 2017. 100 Patients whose sputumor urine tested positive for the presence of K. pneumoniaeisolates were randomly included in the study. Collectedpatient data included age, sex, underlying disease and useof immunosuppressant drugs. The samples were defined ascommunity isolates and hospital isolates depending uponcertain criteria. The cases were divided into infection andcolonization cases. All statistical analyses were performedusing JMP Pro version 12 software.Results: Of the 100 cases investigated, 55 and 45 cases showedthe presence of K. pneumoniae in the sputum and urine,respectively. Of the 100 K. pneumoniae isolates, 21(21%)showed capsular serotype K1 or K2, whereas 28(28%) showedhypermucoviscosity. The prevalence of virulence genes allS,magA, mrkD, rmpA, wabG, kfu-BC, and uge was 16.3%,13%, 81.9%, 18.6%, 90.3%, 38.5%, and 80.5%, respectively.Analysis of microbiological characteristics revealed thatonly rmpA was significantly more frequent in the infectioncases than in the colonization/asymptomatic cases in both thesputum and urine groups.Conclusion: The rmpA-positive K. pneumoniae isolates weredominant in the infection cases compared with those in thecolonization/asymptomatic cases, suggesting that rmpA mayplay a crucial role in the development of UTI and pneumonia.

Giant chorioangioma of placenta: a rare placental cause of polyhydramnios

Chorioangioma belongs to benign nontrophoblastic primary vascular neoplasms of placenta, originating from primitive chorionic mesenchyme and has a cited prevalence of around 0.6% to 1% of all pregnancies. Though majority of them are asymptomatic, clinical course depends mainly on the size of the neoplasm. Giant chorioangiomas (> 4-5 centimetres in diameter) with an approximate prevalence of around one in 9000 to one in 50,000 pregnancies, have been associated with many adverse maternal and fetal complications. We report a case of 21-year-old primigravida lady, who presented to us at 37weeks 4 days period of gestation with backache and with clinically evident increased liquor. On evaluating the cause of her polyhydramnios, ultrasonography revealed a well-defined echogenic vascular mass measuring ~ 8х8 centimetres in the placenta, suggestive of chorioangioma. Though the condition is infrequent, through this case report, we emphasize that even placental factors need to be ruled out in evaluating causes of polyhydramnios. Despite large size of chorioangioma and associated hydramnios, our patient exceptionally didn’t have any fetal complications. With proper antenatal surveillance, optimal feto-maternal outcome can be expected as seen in our case.

Antiphospholipid Syndrome Complicating Pneumococcal Meningitis

Background: Antiphospholipid syndrome is a multisystem auto-immune disordercharacterized by arterial or venous thrombosis in children. Case characteristics: 11-year-old child with pneumococcal meningitis also had cerebral sinus vein thrombosis andpulmonary artery segmental thrombosis. Observation: Pro-thrombotic evaluation showedpositive lupus anticoagulant at baseline and after 12 weeks. Investigations for lupus werenegative at admission and after one year of follow-up. Message: Antiphospholipidsyndrome is a possibility even in thrombosis occurring in the setting of meningitis

Morphometry Of Orbit In South Indian Dry Skulls - Dimensions Of Orbital Roof And Floor

Background: The human orbit is a complex anatomic region. Each of its four bony walls has its own uniquefeatures and is perforated by a number of fissures and foramina that carry important nerves and blood vessels.This is an anatomical region which is of clinical & surgical interest to many disciplines like ophthalmology, oraland maxillofocial surgery and neurosurgery. This morphometric study is undertaken to provide the normalreference values of roof and floor of the orbit in south Indian population.Materials and Methods: The study was done on 200 skulls (105 males and 95 females). The length of orbital roofand floor were measured by using manual vernier caliper. All the data obtained were tabulated and analysedstatistically by computing descriptive statistics like mean, standard deviation and range. Mann-Whitney testwas done to find out the statistical significance of all parameters of orbits, with respect to gender and side (rightand left side).Results: The results showed that the length of orbital roof and floor were significantly larger in males than infemales. There were no significant differences in between the right and left side orbits.Conclusion: This study has compared the orbital roof and floor length between the genders and between the sidesof the skulls. The prior knowledge of the orbital parameters may help to restore the normal anatomy of the orbitduring maxillofacial and reconstructive surgeries.

Orbital Dimensions and Orbital Index: A Measurement Study on South Indian Dry Skulls.

Background: The human orbit is a complex anatomic region, which plays predominant role in the evaluation of craniofacial complex. The bony orbit which lodges the visual apparatus is important not only for anatomists but also for ophthalmologists, oral and maxillofacial surgeons and forensic experts. The objectives of the present study are to provide the normal reference orbital parameters for the South Indian population. Materials and Methods: The study was done on 200 skulls (105 males and 95 females). The orbital height (Ht) and breadth (Br) were measured by using manual vernier caliper. Orbital index was calculated by using the formula Ht /Br x 100. All the data obtained were tabulated and analysed statistically by computing descriptive statistics like mean, standard deviation and range. Mann-Whitney test was done to find out the statistical significance of all parameters of orbits, with respect to gender and side (right and left side). Results: The results showed that the height and breadth were significantly larger in males than in females. There were no significant differences in height and breadth between the right and left side orbits. There was no significant difference in OI between the genders and also sides. According to the OI, the studied group of Indian population comes under Mesoseme category. Conclusion: This study provides useful baseline orbital morphometric data of south Indian population, which are very important during plastic surgery, maxillofacial and neurosurgeries and also in the forensic research.

Leiomyoadenomatoid tumor of the uterus: Report of a rare entity and review of the literature.

Adenomatoid tumor occurs in the testicular spermatic cord and ejaculatory duct in males and in the fallopian tube and uterus in the females. These are usually small, benign lesions and are mostly incidental findings. Leiomyo-adenomatoid tumor (LMAT) is a variant of adenomatoid tumor, where in the smooth muscle component is predominant. Only nine cases of LMAT are reported so far in the English literature. We report one case and review the nine cases reported so far.

Dementia in developing countries: does education play the same role in India as in the West? / Demência nos países em desenvolvimento: a edução desempenha o mesmo papel na Índia como no ocidente

Evidence suggests that education protects from dementia by enhancing cognitive reserve. However, this may be influenced by several socio-demographic factors. Rising numbers of dementia in India, high levels of illiteracy and heterogeneity in socio-demographic factors provide an opportunity to explore this relationship. OBJECTIVE: To study the association between education and age at dementia onset, in relation to socio-demographic factors. METHODS: Association between age at dementia onset and literacy was studied in relationship to potential confounding factors such as gender, bilingualism, place of dwelling, occupation, vascular risk factors, stroke, family history of dementia and dementia subtypes. RESULTS: Case records of 648 dementia patients diagnosed in a specialist clinic in a University hospital in Hyderabad, India were examined. All patients were prospectively enrolled as part of an ongoing longitudinal project that aims to evaluate dementia subjects with detailed clinical, etiological, imaging, and follow-up studies. Of the 648 patients, 98 (15.1%) were illiterate. More than half of illiterate skilled workers were engaged in crafts and skilled agriculture unlike literates who were in trade or clerical jobs. Mean age at onset in illiterates was 60.1 years and in literates 64.5 years (p=0.0002). Factors independently associated with age at dementia onset were bilingualism, rural dwelling and stroke, but not education. CONCLUSION: Our study demonstrates that in India, rural dwelling, bilingualism, stroke and occupation modify the relationship between education and dementia.

Evidências sugerem que a educação protége de demência pelo fortalecimento da reserva cognitiva. Todavia, pode ser influenciado por vários fatores socioeconômicos. O aumento no número de demência na Índia, altos índices de analfabetismo e heterogeneidade de fatores sociodemográficos fornecem uma oportunidade para explorar estas relações. OBJETIVO: Estudar a associação entre educação e idade no início da demência em relação aos fatores sociodemográficos. MÉTODOS: A associação entre idade de início da demência e alfabetismo foi estudado em relação aos potenciais fatores confundidores, como gênero, bilinguismo, local de moradia, ocupação, fatores de risco vasculares, acidente vascular cerebral (AVC), história familiar de demência e subtipos de demência. RESULTADOS: Arquivos de 648 pacientes com demência, diagnosticados numa clínica especializada no Hospital Universitário em Hyderabad, foram avaliados. Todos os pacientes foram prospectivamente incluídos num projeto de acompanhamento longitudinal cujo objetivo é avaliar indivíduos com demência através de estudo de detalhado de acompanhamento clínico, etiológico e de imagem. Dos 648 pacientes, 98 (15%) eram analfabetos. Mais da metade dos analfabetos estavam envolvidos em trabalhos manuais ao contrário dos alfabetizados, envolvidos em comércio ou escritórios. A idade média de início em analfabetos foi de 60,1 anos e entre alfabetizados 64,5 anos de idade (p=0,0002). Os fatores independentemente associados à idade de início da demência foram bilinguismo, AVC, moradia rural, mas não educação. CONCLUSÃO: Nosso estudo demonstra que na Índia, moradia rural, bilinguismo, AVC e ocupação modificam a relação entre educação e demência.

Derivation, characterization and retinal differentiation of induced pluripotent stem cells.

Millions of people world over suffer visual disability due to retinal dystrophies which can be age-related or a genetic disorder resulting in gradual degeneration of the retinal pigmented epithelial (RPE) cells and photoreceptors. Therefore, cell replacement therapy offers a great promise in treating such diseases. Since the adult retina does not harbour any stem cells, alternative stem cell sources like the embryonic stem cells (ESCs) and induced pluripotent stem cells (iPSCs) offer a great promise for generating different cell types of the retina. Here, we report the derivation of four iPSC lines from mouse embryonic fibroblasts (MEFs) using a cocktail of recombinant retroviruses carrying the genes for Oct4, Sox2, Klf4 and cMyc. The iPS clone MEF-4F3 was further characterized for stemness marker expression and stable reprogramming by immunocytochemistry, FACS and RT-PCR analysis. Methylation analysis of the nanog promoter confirmed the reprogrammed epigenetic state. Pluripotency was confirmed by embryoid body (EB) formation and lineage-specific marker expression. Also, upon retinal differentiation, patches of pigmented cells with typical cobble-stone phenotype similar to RPE cells are generated within 6 weeks and they expressed ZO-1 (tight junction protein), RPE65 and bestrophin (mature RPE markers) and showed phagocytic activity by the uptake of fluorescent latex beads.

Cultural differences are reflected in variables associated with carer burden in FTD: A comparison study between India and Australia / Diferenças culturais se refletem nas variáveis associadas à sobrecarga do cuidador em DFT: um estudo comparativo entre Índia e Austrália

ABSTRACT There is great need to understand variables behind carer burden, especially in FTD. Carer burden is a complex construct, and its factors are likely to vary depending on the type of dementia, carer characteristics and cultural background. Objective: The present study aimed to compare profiles and severity of carer burden, depression, anxiety and stress in carers of FTD patients in India in comparison to Australia; to investigate which carer variables are associated with carer burden in each country. Methods: Data of 138 participants (69 dyads of carers-patients) from India and Australia (India, n=31; Australia, n=38). Carer burden was assessed with the short Zarit Burden Inventory; carer depression, anxiety and stress were measured with the Depression, Anxiety and Stress-21. Dementia severity was determined with the Frontotemporal Dementia Rating Scale (FTD-FRS), and a range of demographic variables regarding the carer and patient were also obtained. Results: Overall, levels of carer burden were not significantly different across India and Australia, despite more hours delivering care and higher dementia severity in India. Variables associated with burden, however, differed between countries, with carer depression, anxiety and stress strongly associated with burden in India. By contrast, depression, stress, and dementia severity were associated with burden in Australia. Conclusion: This study demonstrated that variables associated with carer burden in FTD differ between cultures. Consequently, cultural considerations should be taken into account when planning for interventions to reduce burden. This study suggests that addressing carers' skills and coping mechanisms are likely to result in more efficacious outcomes than targeting patient symptoms alone.

RESUMO Há uma grande necessidade de se entender as variáveis por trás da sobrecarga do cuidador, especialmente em DFT. A sobrecarga é um construto complexo e os fatores provavelmente estão ligados ao tipo de demência, características do cuidador e origens culturais. Objetivo: O presente estudo objetivou comparar perfis e gravidade da sobrecarga, depressão, ansiedade e estresse nos cuidadores dos pacientes com DFT da Índia em comparação aos da Austrália; investigar que variáveis do cuidador estão associadas à sobrecarga em cada país. Métodos: Dados de 138 participantes (69 pares cuidadores-pacientes) da Índia e Austrália (Índia, n=31) e Austrália (n=38). A sobrecarga do cuidador foi avaliada através da versão curta do Inventário de Sobrecarga de Zarit; depressão, ansiedade e estresse do cuidador através com o Depression, Anxiety and Stress-21. A gravidade da demência foi determinada com a Frontotemporal Dementia Rating Scale (FTD-FRS), e uma gama de variáveis demográficas do cuidador e do paciente foram também obtidas. Resultados: De modo geral os níveis de sobrecarga do cuidador não foram significativamente diferentes entre Índia e Austrália, apesar do maior tempo despendido no cuidado e gravidade da demência na Índia. As variáveis associadas à sobrecarga, todavia, diferiram entre os países, com depressão do cuidador, ansiedade e estresse fortemente associados com sobrecarga na Índia. Em contraste, depressão, estresse e gravidade da demência foram associados à sobrecarga na Austrália. Conclusão: Este estudo demonstrou que variáveis associadas à sobrecarga do cuidador na DFT difere entre culturas. Consequentemente, aspectos culturais devem ser levados em consideração quando se planeja intervenções para redução da sobrecarga. Este estudo sugere que programas direcionados às habilidades e meios de se lidar com a situação dos cuidadores são provavelmente mais eficazes do que aqueles só aos sintomas do paciente.

T2 weighted MRI in assessment of volume changes during radiotherapy of high grade gliomas.

AIM: To determine whether any changes in gross tumor volume occur between pre treatment MRI and week 5 MRI in high grade gliomas treated by conformal radiotherapy. METHODS AND MATERIALS: Between July 2003-July 2005, 17 patients with WHO grades 3 and 4 malignant gliomas treated with conformal radiotherapy to a total dose of 60 Gy were included in this retrospective study. All patients had undergone T2 weighted MRI a day before treatment and then again at end of week 5 of treatment for definition of initial and boost fields respectively. Gross tumor volumes were delineated on the two MRI's of each patient and the differences were noted. Two patients with multifocal disease were excluded from the final analysis. RESULTS: Of the 15 patients with unifocal disease, 12/15 cases (80%) showed a reduction in tumor volumes (median 54.85 cc). Of these, 4/15 (26.6%) cases (two each of grade 3 and grade 4 gliomas) had an objective reduction in GTV (> or = 50%) and 3/15 (20%) cases (two of grade 4 and one of grade 3 gliomas) demonstrated an increase in tumor volume (median 14 cc). CONCLUSIONS: This study has shown that a change in gross tumor volume occurred in almost all patients on week 5 MRI. The likelihood of treatment success would appear to be decreased if the tumour is not within the treatment field and hence it may be worthwhile to do a mid treatment MRI for definition of boost volumes especially in dose escalation trials employing highly conformal radiotherapy fields.

Thermometry studies of radio-frequency induced hyperthermia on hydrogel based neck phantoms.

A cylindrical phantom, resembling average human neck, was prepared by using hydrogel sheets containing vinyl and polysaccharide. The phantom was used to obtain temperature distributions for 6 values of input power of radio frequency (RF) at 8MHz,by invasive thermometry technique, using thermistor probes.The inclusion of cervical vertebrae and calcium carbonate pieces (human bone representative) with a hollow tube (windpipe equivalent) in the phantom simulates the change in thermal distributions. This is similar to the alterations in heat disposition obtained in the real human neck, during RF induced heating, without extensive distortion of the uniform temperature distribution provided by the RF heating instrument.This paper compares the hydrogel neck phantom with other phantoms, that have been developed for studying thermal distributions and optimization of novel non invasive thermometry techniques in hyperthermic oncology.