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Background: COVID-19 pandemic has caused mental health issues along with physical, social, and economic issues in both patients and their relatives.COVID-19-positive patients were hospitalized in isolation with no or limited access to relatives. These conditions may have contributed to signi?cant psychological distress in relatives and this study was designed to assess the same. To ?nd the prevalence of Depression, Anxiety, and Stress Objectives: among Relatives of hospitalized COVID-19 patients. A cross-sectional quantitative tertiary care hospital-based Methods: study was conducted after approval from Institutional Human Ethics Committee. Relatives of hospitalized COVID-19 patients were assessed by purposive sampling method using Semi-Structured Performa including socio-demographic details, illness- related details, and DASS-21 (Depression, Anxiety, and Stress scale-21) via a telephonic mode of interview. A total of Results: 200 relatives of COVID-19 positive turned negative patients were interviewed on the ?rst day of the COVID 19 negative report. Majority of participants were male,mean age 41 years,literate,married & having ?rst degree relation with the patient. The prevalence of Depression, Anxiety and Stress was 12%. On individual parameters, Depression, Anxiety and Stress was found 25%,21%,and 20% respectively. Female relatives were signi?cantly associated with depression (?2= 8.689,P=.003) & anxiety(?2= 5.790,P=.016) where as longer hospitalization was signi?cantly associated with anxiety(?2= 10.216,P=.006) and stress(?2= 8.936,P=.011). Relatives of COVID-19 patients had a signi?cant amount of psychological stress. Conclusions: Female gender of relatives and longer duration of hospitalization of patients were important predictors.
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Autoimmune hemolytic anemia (AIHA) has been rarely reported worldwide or from India as the underlying cause of anemia in malaria. We hereby present a case of complicated Plasmodium falciparum malaria with concomitant warm AIHA in a 31-year-old male. Direct Antiglobulin Test (DAT) was positive and elution studies showed pan-agglutination reaction. Clinico-hematological and serological follow-up of the patient was done post artesunate treatment until day 9. We suggest that it is important to establish the immune basis of anemia in malaria patients for guiding the treatment plan for the clinicians and providing packed red blood cell transfusion if required.
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Ayurveda is one of the most renowned traditional systems of medicine that has survived and flourished from ages till date. There are many avenues still to be explored by the researchers, practitioners and experts in the field who carry the responsibility of keeping the traditional systems of medicine alive and contributing to their growth in the future. Panchakarma is a fivefold treatment modality in Ayurveda used for detoxification of the body in preventive, curative as well as rejuvenative aspect. It includes Vamana (emesis), Virechana (purgation), Nirooha vasti (decoction enema), Nasya (instillation of medicine through nostrils), and Anuvasana vasti (oil enema). Kashyapa Samhita is a renowned book in Ayurveda especially in the field of Kaumarabritya. It elaborates Panchakarma procedures along with its indications, contraindications and doses for children. It contains many points explained in Brihat trayi along with some unique contributions in the field of Panchakarma. The present article reviews the original text and critically analyses the contribution of Kashyapa Samhita in the field of Panchakarma.
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Background: The potential involvement of Notch signaling pathway in cell fate decision, tumor heterogeneity and angiogenesis in solid tumors can be explored in colorectal cancer (CRC). This might further help to improve outcomes in CRC. Here, the promoter methylation of Notch receptor gene (Notch2 and Notch3) and their co-expression with its downstream transcription factor Hes1 has been analyzed. Methods: Seventy-two CRC patients were enrolled to study the role of Notch2, Notch3 and Hes1 genes in colorectal cancer. Promoter methylation and mRNA expression in tumor and adjoining normal tissue were assessed by Methylation Specific PCR and quantitative Real time PCR respectively. Statistical correlation was done by using SPSS. Results: We found that Notch2 and Notch3 were hypomethylated in 52/72 (72.22%) and 54/72 (75%) cases respectively. Hypomethylation of Notch 2 and Notch 3 showed significant association with advanced stage (p=0.001) and (p=0.003) and nodal metastasis (p=0.036) and (p=0.012) respectively. Both Notch 2 and Notch 3 showed increased mRNA expression in 49 (68.05%) and 51(70.84%) patients with a fold change of 3.37 and 5.43 respectively. Positive correlation between hypomethylation and expression was observed for both genes. High expression of Hes1 was found in 53(73.61%) of cases which was highly relatable with over expression of notch receptor genes. Upregulation of Notch 2, Notch 3 and Hes1 showed significant association with high grade tumors, advance stage and presence of LN metastasis, additionally Notch 3 and Hes1 showed significant association with distant metastasis. Conclusion: Hypomethylation of Notch 2 and 3 receptors is playing crucial role in regulating the expression of these genes in CRC. Overexpression of Notch 2, Notch 3 and Hes1 are associated with disease progression in CRC.
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Background: The COVID-19 has taken the world by storm. It primarily affects the lungs causing respiratory distress and leading to ARDS. Aim: The aim of this study is to evaluate the coagulation dysfunction in patients which predisposes the patients to venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilisation and diffuse intravascular coagulation (DIC). Material & Methods: We assessed 2281 COVID RT PCR positive patients who were admitted with moderate to severe disease in wards and ICU respectively. The coagulation profile was done for each of these patients and the tests included Prothrombin time (PT), Activated Partial Thromboplastin Time (APTT) and D-Dimer. The PT and APTT were estimated on ACL elite pro (Fully automated coagulation analyser) which is based on nephelometry. D- Dimer was measured using ACL elite pro and latex agglutination (semi quantitative method). Results: Out of 2281 COVID RT PCR positive patients 1655 (72.5%) were males and 626 (27.5%) were females. It was observed that percentage of patients admitted in ICU had increased D dimer values and it was statistically significant. Our study showed that larger number of patients admitted in ICU had PT value more than 12.5 seconds and APTT more than 35.5 seconds, however it was not statistically significant. Our study also demonstrated that patients having higher D dimer required longer hospitalization with significant p value. Conclusion: We concluded that assessment of coagulation profile is necessary for patients infected with this virus so as to prevent any thrombotic complications and therefore preventing morbidity and mortality.
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Aim: The aim of this study was to evaluate the intracanal effectiveness of cryotherapy, curcumin irrigant, and normal saline as a final irrigant in reducing postendodontic pain in primary teeth. Materials and Methods: A total of 120 teeth between the ages of 4 and 7 years requiring pulpectomy in primary teeth were included in the study. The teeth were randomly assigned to one of the three treatment groups: intracanal cryotherapy using 2.5°C cold saline, curcumin irrigant, or normal saline. Following completion of chemomechanical preparation, final irrigation with 2.5°C cold saline, curcumin irrigant, and normal saline solution at room temperature were employed in the groups. Participants were asked to rate the severity of their postoperative pain on the Visual Analog Scale before, immediate postoperative after wearing of local anesthetic effect, and 24 h after the procedure. The results were analyzed statistically. Results: The differences in reduction of postendodontic pain between the three irrigating regimens were statistically not significant. Cryotherapy utilizing 2.5°C cold saline or curcumin irrigant can be used instead of normal saline as a final irrigant in pulpectomy of primary teeth. Conclusions: Cryotherapy can be a straightforward, cost-effective, and nontoxic treatment option for the management of postendodontic pain. Curcumin irrigant with its anti-inflammatory properties is also a better alternative as a final irrigant for reducing postoperative pain in primary teeth.
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Extra pulmonary Tuberculosis involving soft tissues and affecting the joints and surrounding structures (tuberculous arthritis) is well known. However, Tubercular myositis is a rare condition with skeletal muscle involvement without underlying osseous or extra osseous involvement in extremely rare presentation. Due to atypical presentation the diagnosis is often delayed. We report and present a case of isolated tubercular myositis of Vastus lateralis muscle in severe osteo arthritis knee patient without evidence of any primary focus
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Objective: The objective of the study is to determine the association between nonsyndromic oral clefts (OC) in children and ABO, Rh blood groups, lip, and dermatoglyphic patterns of their unaffected parents. Methods: This case–control study was conducted at a tertiary cleft center in Chennai, India, among 240 individuals comprising 80 units (40 cases and controls, respectively). Each unit (triad) was constituted by a child (0–12 years of age) either born with nonsyndromic OC (cases) or with no diagnosed congenital anomaly (control) and their unaffected parents (mother and father). ABO and Rh blood groups, specific lip print, fingerprint pattern, and palmar asymmetry were recorded for each individual. Strength of association of related factors was assessed by multivariable logistic regression reported as adjusted odds ratios and 95% confidence interval. Results: A1-positive blood group was found to be considerably higher among case mothers (14.39 [1.57–32.27]). A higher odds of OCs were observed among case mothers with whorl lip pattern (1.51 [1.16–3.17]) and radial loop pattern in fingers (1.44 [1.09–2.31]) relative to controls. In addition, palmar asymmetry was distinctively higher among case parents compared to controls (P < 0.01). Conclusion: Findings indicate that A1-positive blood group, higher frequency of whorl lip, and radial loop finger patterns in mothers and higher ulnar loop pattern in fathers and palmar asymmetry in both parents increases odds of occurrence of OC among their offspring. These identifiable traits offer potential scope for better service planning among resource-constrained disadvantaged communities in India.
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Background: Amniotic fluid is contributed by both mother and foetus. It plays a vital role in foetal growth. The main purpose of this study was to evaluate the foetomaternal outcome in pregnant females with oligohydramnios beyond 36 weeks of gestation.Methods: This study was conducted on 230 pregnant females beyond 36 weeks of gestation with decreased liquor clinically and confirmed sonographically. It was conducted from May 2018 to May 2019. Females with leaking per vaginum, patients who did not give consent and with intrauterine foetal death were excluded. Complete labour record was made. Assessment of maternal outcome was done in terms of mode of delivery and foetal outcome was done in terms of birth weight, Apgar score at one and five-minute, respiratory distress, meconium aspiration, seizures in first 24 hours of life, congenital malformations, neonatal intensive care unit admission and death of baby.Results: A total of 230 pregnant females met the inclusion criteria who were having AFI <5. 121 (53%) females were primigravida and 119 (52%) underwent for caesarean section. Most common indication of LSCS was foetal distress. Apgar score at 1 minute was <7 in 97 (42%) babies and after 5 minutes, it was <7 in 93 (40%) babies. Other neonatal outcome results were IUGR in 59 (26%) babies, meconium aspiration syndrome in 52 (23%) babies, respiratory distress in 92 (40%) babies, congenital malformation in 6 (3%) babies, NICU admission of 93 (40%) babies and neonatal death of 11 (5%) babies.Conclusions: Oligohydramnios increases the chances of maternal morbidity and perinatal morbidity and mortality.
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Background: Amniotic fluid plays a vital role during foetal life. The main purpose of this study was to evaluate the foetomaternal outcome in relation to amniotic fluid index in pregnant females beyond 36 weeks of gestation.Methods: This prospective type of study was conducted for one-year duration from May 2018 to May 2019 in 350 pregnant females beyond 36 weeks of gestation with clinically significant abnormal liquor volume. Clinical diagnosis was later on confirmed with ultrasonography and patients were categorized in three categories as patients with Amniotic fluid index (AFI) 5 to 24, AFI <5 and AFI > or = 25. Complete labour record was made and fetomaternal outcome was assessed.Results: In this study, incidence of oligohydramnios was found to be more than polyhydramnios at term. No significant differences were found in relation to age, parity, religion, residence and booking status in all the study groups. Mostly patients 119 (52%) delivered by caesarean section in oligohydramnios group whereas vaginal delivery was commonly seen in patients with normal AFI (80%) and polyhydramnios (55%). Growth restriction 59 (26%) and malpresentation 18 (8%) were commonly seen with oligohydramnios. In the polyhydramnios group, 14 (35%) babies had malformations whereas only 6 (3%) babies had malformations in patients with oligohydramnios. Significant differences were found in the foetal outcome between the patients with oligohydramnios and polyhydramnios in comparison to patients with normal AFI.Conclusions: In pregnant females with abnormal liquor volume increases the chances of maternal morbidity and perinatal morbidity and mortality.
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Background: Multiple parameters have been developed to prognosticate the outcomes of critically ill newborns admitted in NICUs. The objective of this study is to predict the outcome of newborns admitted in NICU using a simple but efficient score, TOPS score, involving alteration of physiological parameters. Aim of this study was to evaluate role of TOPS score in predicting mortality in sick neonates.Methods: The variables assessed under TOPS score on arrival for all subjects were: Temperature, Oxygen Saturation, Perfusion and blood glucose reading <45 mg/dl. All affected neonates were given treatment as per NICU protocol and outcome was assessed in terms of mortality or discharge using TOPS score. It was prospective study conducted at NICU, Department of Pediatrics, GMERS medical college and general hospital, Gotri, Vadodara. Study population was all admitted neonates aged <28 days at NICU.Results: Mean age of presentation of all cases was 2.8'3.58 days. Hypothermia on admission was observed in 63.3% cases. 40.8% cases had hypoxia. 26.5% neonates recorded poor perfusion. Mortality observed in hypoxic group was 51.7% followed by hypothermic group (46.9%). Highest strength of association was found for poor perfusion, mortality (87.5%) and OR-33.406.' TOPS score was observed to be statistically significant (X2 value is 63.27, p < 0.05) as predictor of mortality. Thus, mortality rate increased with increasing no. of altered TOPS parameters. Regression analysis showed three factors (hypothermia, hypoxia, prolonged CRT) which are consistently associated with p value ? 0.05 for each variable and can be used to predict mortality.Conclusions: All parameters in TOPS score are physiologically important and each parameter carries an independent risk associated with mortality. It is important to note that multiple parameters affected increases the risk. TOPS score is a simple, basic and effective tool to guide about the condition of new born at admission and outcome. of neonatal mortality.
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Obstucted hemivagina with ipsilateral renal anomaly (OHVIRA) syndrome or Herlyn-Werner-Wunderlich syndrome (HWW) is a rare congenital anomaly consist of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis. We are reporting an adolescent girl with orofacial defect who presented with lower abdominal pain. She attained menarche 3 months earlier and had a regular menstrual cycle with cyclical abdominal pain. On abdominal examination a firm, mobile tender mass extending from left iliac fossa up to umbilicus (24 weeks size) was found. Lower border of mass could not be approached. Further evaluation with ultrasound showed enlarged uterus with collection with internal echoes and non-visualization of the left kidney. CECT showed absent left kidney and didelphys uterus with large left hematocolpometra with left complex adenexal cyst. Patient was posted for hematocolpos drainage and vaginoplasty. An unusual presentation of regular menstruation and nonspecific abdominal pain delays the diagnosis, which can lead to severe complications such as endometriosis and infertility.
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The disorders of gastrointestinal tract are responsible for a great deal of morbidity and mortality. The present study was conducted to determine lesions of gastrointestinal tract. Methods: This present study was conducted on 62 specimens of GIT tract. Biopsies from the gastrointestinal sites such as esophagus, pharynx, stomach, duodenum, liver, small intestine, colon, rectum and anal canal were obtained. Results: Maximum specimens were obtained from age group 21-30 years (24), followed by 11-20 years (16), 31-40 years (10), 41-50 years (8) and >50 years (4). 50 lesions were nonneoplastic and 12 were neoplastic. Most common non- neoplastic lesions were seen in gall bladder followed by esophagus (10) and small intestine (5). In neoplastic lesions, most common organ involved was gall bladder (5) followed by esophagus (3). In non- neoplastic lesions, chronic inflammatory lesion of oesophagus was seen in 10, appendicular lesions in 3, gall bladder lesions in 26, colonic perforation in 4, crohn’s disease of small intestine in 5 and peptic ulcers in 2. Neoplastic lesions were SCC of esophagus in 3, adenocarcinoma of small intestine in 1, adenocarcinoma of large intestine in 1, SCC of stomach in 2 and adeonma of gall bladder in 5 cases. Conclusion: Authors found that most commonly non- neoplastic lesions were seen involving gall bladder and in age group 21-30 years.
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Aim: The aim of this study was to determine the sealing ability of three different materials mineral trioxide aggregate (MTA) Plus, bone cement, and calcium sulfate with self-etch adhesive (SEA) for the repair of furcal perforation, using dye extraction method. Materials and Methods: Forty-eight extracted human permanent first and second molars were included and randomly divided into four groups: Group 1, n = 12, negative control, perforation not repaired with any material, Group 2, n = 12, perforation repair material used, MTA Plus, Group 3, n = 12, perforation repair material used, calcium sulfate with SEA, Group 4, n = 12, perforation repair material used, bone cement. The teeth were then coated with two coats of clear nail varnish immersed in methylene blue dye for 24 h, kept in 65% concentrated nitric acid for 3 days. Dye leakage was measured with the dye extraction method using a spectrophotometer at 550 nm. Results: The negative control showed the highest mean values of dye absorbance (1.45). Bone cement (0.94) came second. Calcium sulfate with SEA (0.58) and MTA Plus (0.32) had no significant difference in their dye absorbance values. Conclusion: Within the limitations of the study, MTA Plus showed the least microleakage followed by calcium sulfate with SEA which has shown promising results and can be used as an alternative followed by bone cement which showed the highest microleakage.
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Background: Acute kidney injury (AKI) is defined as an acute deterioration in ability of the kidneys to maintain homeostasis of body fluids and electrolytes leading to retention of wasted and toxic metabolic end products. It is fairly common in newborn population and is a major contributor of neonatal mortality and morbidity. The aim was to study the incidence of renal failure in high risk neonates and risk factors for renal failure.Methods: A prospective observational study was done to evaluate renal profile in high risk neonates admitted to neonatal intensive care unit, GMERS Medical College and General Hospital, Gotri, Vadodara, Gujarat, India over a 1-year period. nRifle criteria was used for classification of acute kidney injury.Results: The incidence of AKI in high risk newborns admitted in this study was 52 (37.14%). The male to female ratio in current study was 2.46:1. Majority of neonates with AKI were out born 44 (84.6%). The incidence of AKI was higher in term newborns. Mean weight in AKI group was 2048 grams. The highest incidence of AKI was found in AFD newborns (57.69%). nRifle criteria was used to diagnose AKI in this study. Out of 52 neonates who had AKI, 27 (51.9%) were in risk category, 21 (40.4%) were in injury group and 4 (7.7%) were in failure group. Mortality in these groups were 5 (18.51%), 7 (33.33%) and 3 (75%) respectively. Highest correlation of risk factors for AKI was found with birth asphyxia 18 (34.9%) followed by sepsis 12 (23.1%) and shock 15 (28.5%). 29 (55.76%) neonates had non oliguric AKI. 28 (53.8%) neonates with AKI developed dyselectrolytemia.Conclusions: Early recognition and management of risk factors can help in reducing the occurrence and improve outcomes in them.
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Background: Neonatal hypernatremia is less common but significant' metabolic problem' with acute morbidity as well as long term consequences. Many causative' factors have been identified such' as inadequate breastfeeding, hot' weather with high' evaporative losses ,' infections etc. It is important to identify, anticipate and correct the condition before it leads to damaging consequences. The objective of the present study was evaluation of clinical profile, renal parameters and causative factors associated with hypernatremia in exclusively breast-fed infants.Methods: A retrospective review of' 30 new-borns less than 28 days of age admitted in' GMERS General hospital for hypernatremia was conducted. The study group included inborn and out born admissions. Records were reviewed, feeding history, severity of hypernatremia and altered renal parameters were analysed. The study period was from April 2018to June2018i.e summer months.Results: Total NICU admissions were 303 during these months' out of which 30 were diagnosed' with hypernatremia completely and discharged. Mean age of presentation was 8.4 days. Sodium levels ranged from 146-179 mmol/l. Mild hypernatremia was most common (56.7%), followed by moderate hypernatremia in 40%. All neonates were on' exclusive breast feeding. Majority of the affected neonates were term SGA followed by term AGA and preterm AGA. Renal parameters were altered in quarter of affected' infants.' Most common clinical feature noted was lethargy(70%), followed' by fever(53.3%),significant weight loss ,jaundice and dehydration. 29 patients were successfully discharged on breast milk feeding.Conclusions: Hypernatremia though rare, is common in young infants in summer months. It is preventable and treatable condition. It is important to anticipate, identify and treat such patients at the earliest. Treating physicians and nursing staff should be more vigilant for establishment of breast feeding in low birth weight infants. Exclusive breast feeding for first six months of life should always be promoted.
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Objective: To determine effect of Premature Infant Oral Motor Intervention program on oro-motor function and time to full independent wati spoon feeds in preterm infants. Methods: 30preterm infants between 28-32 weeks of gestation on full gavage feeds of 150 mL/kg/daywere randomized to receive either pre-feed oro-motor stimulation using Premature InfantOral Motor Intervention (structured stimulation) or sham intervention (unstructuredstimulation). Results: Improvement in mean (SD) Neonatal Oro-Motor Assessment Scale(NOMAS) over 7 days from baseline was significantly higher in the study group infants ascompared to control group (9.25 (1.73) vs 4.79 (1.52), P=0.001). Infants in the study groupreached full independent wati spoon feeds significantly earlier than the infants in controlgroup (4.0 (0.8) d; vs 6.64 (1.0) d; P=0.001). There was significant increase in weight gainafter enrolment in infants in study group compared to those in control group. Conclusions:Oral stimulation program improves the oro-motor skills and growth velocity in 28-32 weekpreterm infants. There is decreased transition time from gavage to full independent feeds bymouth
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Over the years, a lot has developed in the field of infertility and artificial reproductive techniques worldwide, but the uterine factor infertility still remains an unresolved issue in reproductive medicine. Absolute uterine factor infertility is synonymous with congenital absence of uterus or a physiologically nonfunctioning uterus. Very few options including surrogacy and adoption are available for these patients. Both surrogacy and adoption are associated with legal, ethical, financial, religious, and psychological issues. For some of these patients, uterine transplant could be a viable option in future. However, the ability of uterus to carry the pregnancy to the period of viability and the effect of immunosuppressant on the fetus make the uterine transplant a more complex operation than any other transplants. From the earliest uterine transplant tried in 1931 in Germany to the first successful child birth following transplant in Sweden in 2014, uterine transplantation has come a long way. Among the countries that have tried this till now, Sweden has reported five cases of successful births posttransplant. Behind these successful cases, there is dedication and perseverance of few individuals who continued their efforts in spite of repeated failures. At the moment, the uterine transplant can be considered experimental at the best. However, considering the large number of hysterectomies done all over the world and uteruses available for transplantation, uterine transplant has potential to surpass, in numbers, the other transplant in near future.
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Background&Objective:To study the patterns of psychiatric referrals in a newly established tertiary care teaching Hospital has been important for understanding consultation liaison psychiatry and setting up better general hospital psychiatric units. The aim of the present study was to study referral characteristics’ of patients of various departments to psychiatric unit at a tertiary care teaching hospital.Methodology:All referrals made to psychiatry department over a period of one year were assessed by psychiatrist based on structured performa including demographic data, referring department, referral note, present complaints, past history of psychiatric illness, family history of psychiatric illness, mental status examination and DSM –IV-TR criteria to diagnose psychiatric illness and analyzed.Results:Out of 400 referred patients to psychiatry unit over a period of one year, majority were from Medicine department (62.75%). Substance use disorder (37.25%) was the most common diagnosis followed by depressive disorders (15.75%) and anxiety disorders (8.25%). 235 (58.75%) references were with statement like ‘psychiatry reference’ and no reason mentioned for that. Significantly higher proportions of OPD referrals (71.81%) were made with statement like ‘psychiatry reference’ and no reason mentioned for that as compared IPD referrals (41.62%). Significantly higher proportions of patients (66.75%) with past history of psychiatric illness were referred with statement like ‘psychiatry reference’ and no reason mentioned for that as compared to patients (52.81%) without past history of psychiatric illness. Conclusion:Study highlights importance of consultation-liaison psychiatry through referral pattern in a tertiary care teaching hospital. More referrals for Substance use disorders suggest emerging need to develop separate deaddiction services in our setting. Past history of psychiatric illness was considered significant factor for referrals from other departments and majority of references were without any details. There is need to sensitize other specialists, especially general physicians who are the common source of referrals regarding common psychiatric conditions and proper referral note to improve consultation liaison psychiatry in general hospital setup.