A novel case of left atrial and right lung mass turned out to be unconventional metastasis of uterine leiomyosarcoma with a review of literature

Uterine leiomyosarcoma (ULMS) is a rare malignancy arising from the myometrial smooth muscle wall, and cardiac metastases are extremely rare. Metastasis to the heart is a very unusual finding, and atrial metastasis is even rarer. Here, we report a case of a 45 year old woman who presented with dyspnea and pleural effusion and had a significant history of hysterectomy done for ULMS. Magnetic resonance imaging revealed a left atrial mass, which was resected and revealed to be a metastasis of leiomyosarcoma on histopathology and immunohistochemistry. Metastatic ULMS may rarely present as a left atrial mass with acute clinical presentation. Detailed clinical history and accurate diagnosis are vital for further management.

A Community Based Cross-Sectional Study to Assess the Socio-Economic and Health Status of Rag Pickers in Varanasi slums, North India

Background- Rag picking is one of the inferior economic activities in the urban informal sector, largely undertaken by children belonging to weaker sections of society for their survival and for supplementing their family income. Rag picking is one of the most dangerous activities in India. Rag pickers are working in a filthy environment surrounded by dust, dogs, and pigs. They suffer from many diseases, such as respiratory problems, anemia, fever, and other problems which include cuts, rashes, and injuries. Waste pickers are the general term adopted by the 1 st World Conference of Waste Pickers in 2008. Objective- [a] To assess the socio-economic condition of ragpickers in Varanasi, [b] To know the health condition and treatment behavior of ragpickers in Varanasi. Materials and Methods- A community-based descriptive cross-sectional study in which ragpickers reside in the slum area of Varanasi. All men and women present at the time of the interview who were involved in rag picking from the last 6 months were included. Seriously ill men and women were excluded. Since we had no prior knowledge about the proportion of cases (P) so a pilot study was conducted in which prevalence of health problem found in rag pickers in the last 6 months (P) = 0.90. Total estimated sample size is 100. In this study, Simple Random sampling was used. By using this sampling 100 individuals were selected randomly, fulfilling the inclusion criteria. Results-82 (82.0%) rag pickers were not educated in which 75 (91.5%) rag pickers suffered from health problems. Maximum 74 (74.0 %) rag pickers were migrants. Maximum 74 (74.0%) rag pickers were married in which 36 (48.0 %) rag pickers were married between 14- 18 ages. 80 (80.0%) rag pickers had not used any precautionary measure during rag picking in which 73 (91.2%) rag pickers faced health problems. Maximum 39(39.0%) were affected by dust during rag picking. Only 17(17%) ragpickers preferred government hospitals for treatment. 75 (75.0 %) rag pickers were addicted to intoxication in which 66 (88.0%) rag pickers faced health problems. 91 (91%) ragpickers affected by any health problems in the last 6 months in which a maximum of 63.7% of rag pickers suffered from fever, 60.4% of rag pickers complained about injuries, 56.2 % of rag pickers suffered from weakness problems, 52.7% of rag pickers affected by cough problems. There is a highly significance between educational status and any kind of intoxication. Discussion- The literacy level among the rag pickers was 18% which is much lower than the average literacy rate of Varanasi 75.60% (2011census). A study on slum dwellers in Dhaka showed the literacy rate higher than the finding of this study (18 vs 25 %). 28.0% of rag pickers adopted this work because they had no education. There is a high significance between educational status and any kind of intoxication. Chances of intoxication are high when no education among rag pickers. It is highly significant between educational status and health problems of rag pickers in the last 6 months. Uneducated rag pickers were not aware of the health effects.

A study of the different learning styles of the present first professional MBBS students at United Institute of Medical Sciences, United Medicity, Prayagraj, India

Background: The study is designed to evaluate the different learning styles of the present first professional MBBS students. Students were requested to complete the visual-aural-read/write-kinesthetic (VARK) questionnaire at VARK-LEARN.COM. Results of the questionnaire were collected by email and analyzed using Microsoft Excel. We found that 68.2% had multimodal learning preferences and 31.7% had single learning preference. Aims and Objectives: The objective of this study is to analyze the different learning styles of MBBS 1st year students of United Institute of Medical Sciences, Prayagraj, using the VARK questionnaire. Materials and Methods: This study includes the informed consent taken from each student before participating. The Institutional Ethics Committee approved the study. Copyright permission was taken from the website vark-learn.com, from VARK Learn Limited, New Zealand. One hundred and two students had consented, and out of them, 85 students participated in the study. The students were asked to complete the questionnaire on the website. The data on their learning styles were collected and analyzed using Microsoft Excel. Results: Out of 85 Students, 58 (68.2%) had multimodal learning preferences. Of these, 28.2% of students had four-part VARK or quadrimodal preferences, 28.2% of students had bimodal, and 11.7% had trimodal learning preferences. Twenty-seven (31.7%) had single learning preferences, and, out of these 27 students, 17 (20%) had kinesthetic, 6 (7.05%) had visual learning preferences, and 4 (4.7%) students had aural learning preferences. Conclusion: With the help of this study, we concluded that most of the students who participated in our study are multimodal learners, and out of the students who had a single learning preference, most had kinesthetic learning preferences.

Midterm eGFR Predicts Pregnancy Outcomes: An Observational Study

Introduction: The hemodynamic adjustments during pregnancy play a pivotal role in sustaining the gestation, however, its clinical connotation on midterm renal hyperfiltration and its consequence on maternal and fetal outcomes need a greater appraisal. The present retrospective study looked into the midterm estimated glomerular filtration rate (eGFR) among pregnant females without overt pieces of evidence of chronic kidney disease (CKD) as a surrogate marker for midterm hyperfiltration and its implication on maternal and fetal outcomes. Materials and methods: All pregnancies among females aged 18–50 years with available pregestational baseline serum creatinine were included in the study. Maternal renal hyperfiltration was expressed as the highest eGFR, using the creatinine clearance method. Its association with adverse maternal and fetal outcomes was assessed. Results: A total of 1,045 pregnancies were assessed during the study. According to midterm eGFR, among them, 65% of pregnancies showed midterm eGFR between 120 and 150, however, 4.3% of pregnancies had values more than 150 mL/min per 1.73 m2 . The risk of poor pregnancy outcome was observed for eGFR levels below and above the reference level of 120–150 mL/min per 1.73 m2 (1.97 for values ?150 mL/min per 1.73 m2 , and 1.72 for 90–120 mL/min per 1.73 m2 ). Pregnancies with eGFR between 60 and 90 mL/min per 1.73 m2 had odds ratios (ORs) of 5.64. Conclusion: A distinctive relationship was observed between the midterm eGFR and adverse pregnancy outcomes with the best outcomes for midterm eGFR levels between 120 and 150 mL/min per 1.73 m2 . Despite no apparent functional renal deterioration, a poor maternal hyperfiltration response may play a crucial impact on poor pregnancy outcomes.

Syndrome Z: Its Response to CPAP Therapy

Background: Metabolic syndrome is a constellation of cardiovascular risk factors and its prevalence in obstructive sleep apnea (OSA) is high. The association of OSA and metabolic syndrome is termed as syndrome Z. The effect of continuous positive airway pressure (CPAP) on metabolic syndrome is still controversial. Materials and methods: A total of 145 newly diagnosed patients with OSA were enrolled in this prospective interventional study, who underwent CPAP therapy for 8 weeks. Baseline data including anthropometric variables, blood pressure, fasting glucose levels, insulin resistance and fasting lipid profile of all the study patients were collected before and after the intervention. We determined prevalence of metabolic syndrome in OSA and the effect of CPAP on the components of metabolic syndrome was determined. Results: One hundred-and-six (73.1%) patients were found to have metabolic syndrome. Eighty-four patients were compliant with CPAP therapy. There was statistically significant reduction in glucose systolic (5.5 mm Hg, p = 0.001) and diastolic blood pressure (3.5 mm Hg, p = 0.002), fasting (4.2 mg/dL, p = 0.02), homeostasis model assessment insulin resistance (1.4, p = 0.04) and triglycerides (17.3 mg/dL, p = 0.008) after CPAP therapy. There was modest reversal of metabolic syndrome manifestations in 22 of 84 patients (26.2%) after CPAP therapy. In the CPAP complaint group, a significant reduction in dyslipidemia (p = 0.04) was noted compared to non-compliant group. Conclusion: In patients with syndrome Z, 8 weeks of CPAP therapy was associated with reduction in both systolic and diastolic blood pressure, insulin resistance and triglycerides and modest reversal of metabolic syndrome manifestations.

Successful treatment of POEMS syndrome in a young male with stem cell transplantation

POEMs syndrome is a rare paraneoplastic disorder related to plasma cell dyscrasia. The present study deals with anunusual case of POEMs syndrome in a young male who came with ascending demyelinating polyneuropathy, resultingin complete quadriparesis. The diagnosis was based on clinical findings of gynecomastia, hyperpigmentation andhypertrichosis of skin and lymphadenitis. Detailed laboratory investigations and imaging confirmed POEMS syndrome.In view of the rapidly progressing polyneuropathy, the patient was treated with chemotherapy followed by stem celltransplantation. The patient recovered completely after the treatment.

Correlation of Maternal Age with Prevalence of Chromosomal Anomalies in Patients of Anorectal Malformation

Introduction: Aims: To identify the Anorectal malformations patients in North Indian region and then study the karyotype of these patients to evaluate cytogenetic aberrations and then correlate it with the maternal age. Subjects and Methods: Forty eight patients of anorectal malformation were selected from Department of Paediatric Surgery, KGMU, UP, Lucknow. Blood samples were collected and their cytogenetic study was done in the Department of Anatomy, KGMU-U.P, Lucknow. Karyotypes obtained were further analysed. Results: Out of 48 children enrolled in the study, karyogram could be obtained for 45 cases (93.75%). Maternal age at the time of birth of the child was <30 years in 91.1% cases. There were only 8.9% women who were >30 years of age at the time of birth of the child. However, proportion of those with anomalies was significantly higher in >30 years age group (75%) as compared to that in <30 years age group (2.4%). Conclusion: Although low maternal age was found most commonly, but number of cases with chromosomal anomalies was reported more in >30 years of age, which could be due to increased risk of congenital anomalies and malformations with advanced age.

Role of Serum Osteoprotegerin as a Diagnostic Indicator of Primary Osteoporosis in Perimenopausal and Postmenopausal Women: An Indian Perspective

@#Introduction:Osteoporosis (OP) is a major health problem in the older population. The aim of the study was to assess the role of serum osteoprotegerin (OPG) as a diagnostic indicator of primary osteoporosis in peri- and postmenopausal women in an Indian population. Materials and Methods: After ethical approval, 90 cases (45 cases and 45 controls) of peri- and post-menopausal females above 40 years of age presenting to our outpatient department were included in the study. It was a case controlled study conducted between July 2014 to July 2015. Based on the clinical features, t-score and radiological evidence from the DEXA scan, they were equally divided into two groups (cases and controls). Serum osteoprotegerin (OPG) levels were measured amongst cases and controls. Results:The total calcium (mg/dl) level was lower among the cases and the difference was significant (p-Value= <0.001). Similarly, alkaline phosphatase (u/l), osteoprotegerin (u/ml) levels were higher in the cases as compared to controls and the difference was significant (p-Value= <0.001). The mean osteoprotegerin level showed a slight increase with increase in severity of the grading of BMD of spine. The results suggested a cut-off value of ≥10.5 u/ml (86.7% sensitive and 80% specific with accuracy of 84.5%) between normal and osteoporosis. Conclusion: From the present study, we conclude that osteoprotegerin is a valid biomarker to diagnose postmenopausal women with low bone mineral density.

Protective role of diet supplements Spirulina and Tamarind fruit pulp on kidney in sodium fluoride exposed Swiss albino mice: Histological and biochemical indices.

Fluoride toxicity through potable water, particularly ground water, is not uncommon in countries such as India, China, Iran, Iraq, Turkey, parts of Africa and Afghanistan. Kidney being the main organ involved in fluoride removal, it accumulates considerable amount of fluoride. Here, we report toxic effects of oral exposure of Swiss albino mice to fluoride (sub-acute: 190 mg/kg body wt. for 7days; and sub-chronic: 94 mg/kg body wt. for 90 days) and recovery of sub-chronic fluoride exposed mice after 90 days of sodium fluoride (NaF) withdrawal. The role of diet supplements (Spirulina and tamarind fruit pulp @ 230 mg/kg body wt. independently as well as in combination) in amelioration of fluoride toxicity has also been screened. Compared with controls, feed intake decreased from 3-43%, body wt. 4-18%, and kidney wt. 5-12% in treated mice (except diet supplement groups of sub-chronic exposure) while their water intake increased from 4-43%. Histopathological changes in the cortical region of kidney in fluoride treated mice were as follows: dilation of bowman’s capsule and thickening of its parietal and visceral layer; alterations in glomeruli size and their sclerotization; increase in bowman’s space; proliferation of mesangial cells; reduction in podocyte counts; and dilation of proximal and distal tubules. Fluoride exposure altered tissue biochemistry (protein, acid phosphatase and alkaline phosphatase content) and increased urea (23-58%) and creatinine content (14-127%) in the serum. Sub-acute exposure was found more toxic. The diet modulation not only reduced fluoride toxicity but also led to better recovery of treated mice after withdrawal, especially in combination.

Detection of rifampicin resistance in tuberculosis by molecular methods: A report from Eastern Uttar Pradesh, India.

Diagnosis of drug resistance tuberculosis (TB) by the gold standard method is labour intensive and time consuming. Hence, there is an urgent need for introduction of rapid diagnostic techniques. Line probe assay (LPA) and cartridge‑based nucleic acid amplification test (CBNAAT) have been introduced in India under Revised National Tuberculosis Control Program. Spot and morning sputum samples of previously treated patients by anti‑TB drugs were subjected to LPA or CBNAAT. Total 682/1253 (54.4%) were diagnosed as rifampicin‑resistant. The patients could be diagnosed early by molecular methods and put on second line treatment.

A Clinical Study of Hearing Outcome after Type I Tympanoplasty

Introduction: This study was aimed to assess the hearing outcome after type I tympanoplasty using temporalis fascia graft, to assess the factors which influence the outcome and to evaluate the result of our study and to compare our data with similarly published study. Materials and methods: The study was conducted at NSCB Medical College and Hospital, Jabalpur in the Department of Otorhinolaryngology after obtaining approval from the institutional ethics committee, from October 2014 till October 2015. Patients, aged 15 to 45 years, presenting with perforated tympanic membrane were consented. Audiological evaluation was done preoperatively, 1 month and 3 month after tympanoplasty. Results: During the study period 45 type I Tympanoplasty were performed using temporalis fascia as graft, 24 males. 21 cases below the age of 26 years showed graft take up of 84% and the mean hearing gain of 11.37 dB. 77% of those belonging to low socioeconomic group showed graft take up of 76.9% with mean hearing gain of 12.03 dB and 88% of those belonging to high socio economic group showed graft take up of 87.5% with mean hearing gain of 11.14 dB. Out of 21 cases which had perforation size <50% 20 showed graft take up of 95.23% with mean hearing gain of 11.77 dB. Conclusions: Graft uptake is independent of gender, age of the patient. Pre operative dry ear status is directly related to the outcome of surgery. Graft take up is better in perforation size less that 50% but hearing gain will be more in perforation size of more than 50%.

A study of Adenoid Facies: Clinico-radiological correlation and its sequalae

Introduction: This study aimed to clinically correlate adenoid facies with various clinical features related to ear, nose and throat and to broadly study the various sequelae of adenoid hypertrophy on the physical, mental as well as the social conditioning of children. Materials and methods: After taking approval of the institutional ethics committee the study was carried out in the department of Otorhinolaryngology and Head and Neck Surgery Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur from January 2012 till December 2012. Patients who presented to the outpatient clinic or were admitted in the indoor ward with adenoid facies were included in the study. After detailed history taking and clinical examination, data was analysed with appropriate statistical methods. Results: 30 patients with adenoid facies of varying degrees were included in the study. Nasal block was the most commonly presenting symptom. Pain in throat was complained of by 66.66% of cases. In 50% of cases the parents complained of irregular dentition. Decreased airflow upon functional examination of the nose was seen to be bilateral in majority of cases. A hitched upper lip was found in 100% of cases. High arched palate was seen in all cases, grade III tonsil enlargement was seen in 63.33% cases while grade II tonsil enlargement was seen in 30%. It was seen that mastoid pneumatization was affected by adenoids, being partial cellular in 48.33% of the cases and sclerosed in 18.33% ears. Conclusions: This study concluded that adenoids affect each part of ear nose and throat system, thus its effect can actually be quite devastating in growing children

Audiometric analysis of different causes of hearing loss in patients attending a tertiary level hospital in India

Background: We sought to understand the audiometric profile of various causes of hearing loss in our patients. Patients were classified as conductive and sensorineural hearing loss along with their specific etiopathological causes. Materials and methods: After approval of the ethics committee, we enrolled patients from our outpatient clinic that presented with complaints of hearing loss. All patients underwent general and systemic examination to ascertain the etiopathological cause of their hearing loss, followed by audiometric analysis. The data was analysed using appropriate statistical methods. Results: 100 patients were included in our study, of which 16 had mild, 36 moderate, 28 severe and 15 had profound hearing loss. Chronic suppurative otitis media was the commonest cause of conductive hearing loss, with majority having moderate level hearing loss. Congenital causes were the commonest in sensorineural hearing loss, of which 12 had profound hearing loss. Conclusion: Audiometric analysis helps in determining the prognostic evaluation of the patients. This study calls for similar research in different geographical locations

Clinical profile of patients of epistaxis: An experience from a tertiary level hospital in Jabalpur

Introduction: Epistaxis is one of the most common encountered otolaryngologic emergency and affects up to 60% of the population in their lifetime, of which 6% require medical attention. This study was done to find out the relationship between general diseases and the occurrence of epistaxis and to evaluate the methods required to manage bleeding from the nose. Materials and methods: Cases were taken for this study from various indoor and outpatient departments of N.S.C.B Medical College and Hospital Jabalpur from October 2013 till September 2014. Detailed history, clinical information was noted for all patients. All included patients underwent investigations as ordered by their doctor, and relevant clinical examinations were performed. Data was analyzed using appropriate statistical methods. Results: In this study, maximum number of subjects had bleeding from both nares followed by left and right nares respectively. Deviation to left was more common in this study with not much significant difference between the two sides. Tumors of nose (17.78%) were the most common associated disease in this study followed by hypertension (13.3%), diabetes mellitus was associated with 6.67% of subjects. 11.11% patients had nasal bone fracture and 11.11% of patients had enlarged external framework of nose mainly due to nasal masses. Most commonly used modality was anterior nasal packing in 40% cases, followed by surgery in 35.56% cases. Conclusions: These results illustrate the relation of epistaxis with past medical history, duration of bleeding. More research is required to understand the management patterns in different geographical locations.

Treatment of patients with metastatic pancreatic cancer: Experience from a tertiary Indian cancer center.

BACKGROUND: The aim of this study was to look at the outcome of patients with metastatic pancreatic cancer treated at a tertiary cancer center in India. PATIENTS AND METHODS: A total of 101 patients with locally advanced and metastatic pancreatic cancer diagnosed between May 2012 and July 2013 were identified from a prospectively maintained database at the tertiary cancer center. Overall survival (OS) was computed using the Kaplan–Meir product limit method and compared across groups using the log‑rank statistics. Cox proportional hazards model, adjusted for a number of patient and tumor characteristics, was then used to determine factors prognostic for OS. RESULTS: Median age at diagnosis was 55 years (range: 21–81 years). 57.4% (n = 58) of patients were male, 22% (n = 22) had performance status (PS) of <2 at diagnosis and 89% received first‑line chemotherapy, while the rest received best supportive care. For the whole cohort, 6 month and 1‑year OS was 57% (95% confidence interval [CI]: 46–66%) and 47% (95% CI: 35–57%), respectively. In a multivariable model, PS <2 and oligometastatic disease were associated with a significantly decreased risk of death. CONCLUSION: Results from our analysis indicate that the prognostic outcome among Indian patients with metastatic pancreatic cancer is poor with survival outcomes similar to those reported in North America and Europe.

Superbugs causing ventilator associated pneumonia in a tertiary care hospital and the return of pre‑antibiotic era.

The rise in super bugs causing Ventilator‑Associated Pneumonia (VAP) is a major cause of mortality and morbidity despite recent advances in management owing to the looming ‘antibiotic apocalypse’. The aetiology and susceptibility pattern of the VAP isolates varies with patient population, type of intensive care unit (ICU) and is an urgent diagnostic challenge. The present study carried out for a period of one year in a tertiary care hospital, enrolled patients on mechanical ventilation (MV) for ≥48 hrs. Endotracheal aspirates (ETA) from suspected VAP patients were processed by semi quantitative method. Staphylococus aureus, members of Enterobacteriaceae were more common in early onset VAP (EOVAP), while Nonfermenting Gram negative bacilli (NFGNB) were significantly associated with late onset VAP (LOVAP). Most of the isolates were multi drug resistant (MDR) super bugs. With limited treatment options left for this crisis situation like the pre‑antibiotic era; it is an alarm for rational antibiotic therapy usage and intensive education programs.

Kinetic constraints and features imposed by the immobilization of enzymes onto solid matrices: A key to advanced biotransformation.

The kinetics of immobilized enzymes can not be analyzed by means of the simple Michaelis-Menten concept, which generally fails to describe the immobilized state due to both its probable barriers, and because the active concentration of the enzyme approaches, or even exceeds this of its substrate(s). In such cases, the various experimental data are usually treated by complex rate equations comprising too many parameters acquiring different natures and meanings, depending on both the properties of the immobilization state and the experimental conditions; thus, more likely, only apparent values of the Michaelis-Menten kinetic parameters can be estimated experimentally. Likewise, immobilization is often a key method in optimizing the operational performance of enzymes, in both laboratory and industrial scale, and affects considerably the kinetics in non-aqueous and non-conventional media due to several issues as the structural changes of the enzyme molecule, the heterogeneity of the system, and the partial or total absence of water. In this work a theoretical approach is described on the formulation of simplified rate equations, reflecting also the actual mass balances of the reactants, in the case where esterification synthetic reactions are catalyzed by immobilized lipases, in either a non-aqueous organic solvent or in a non-solvent system.