ANAESTHETIC MANAGEMENT OF A PATIENT WITH HYPERHOMOCYSTEINEMIA FOR TOTAL ABDOMINAL HYSTERECTOMY

Hyperhomocysteinemia is a disorder caused by a disruption of any of the enzymes or cofactors involved in the pathways of homocysteine metabolism. The resultant high plasma levels of homocysteine increase the risk for thromboembolic events. These patients are frequently anticoagulated in the perioperative setup. Interruption of anticoagulant therapy may subject the patient to an increased risk of thrombosis, infarction, and death. Neuraxial anaesthesia techniques may be relatively contraindicated in anticoagulated patients and nitrous oxide may exacerbate the condition by inhibiting the conversion of homocysteine to methionine. We describe a case of the anaesthetic management of a unique case of hyperhomocysteinemia with multiple recent thrombotic episodes proposed for total abdominal hysterectomy conducted under general anaesthesia, the intraoperative and postoperative monitoring and considerations.

Significance of Laboratory Markers in Predicting the Severity of COVID-19 in the Central Reserve Police Force Front-line Workers with a Review of Literature

COVID-19 disease has variable clinical presentations, ranging from asymptomatic to mild symptoms to severe manifestation with pneumonia, acute respiratory distress syndrome, septic shock, disseminated intravascular coagulation, and/or multiple organ failure. The real?time reverse transcription–polymerase chain reaction is gold standard test for severe acute respiratory syndrome?coronavirus?2 detection. In the present study, we aimed to predict the significance of various hematological and biochemical markers for early identification of complications and assessing the severity of the disease. A total of cases were divided into two study groups, namely, severe and nonsevere based on clinical presentation. Out of 210 cases, 186 (88.5%) cases were nonsevere and 24 (11.5%) cases were severe. Among various hematological and biochemical markers studied, hemoglobin, total leukocyte count, neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, albumin, lactate dehydrogenase, C?reactive protein, ferritin, D?dimer, and interleukin?6 are found to have P < 0.05 and significantly correlated with the severity of disease.

Neuroimaging In Tuberous Sclerosis

Tuberous sclerosis is a rare autosomal dominant neurocutaneous syndrome. The diagnosis is on the basis of diagnostic criteria applied to clinical findings classical triad of epilepsy, mental retardation, and adenoma sebaceum. Cardiac rhabdomyoma, renal angiomyolipoma, and neurologic involvement comprises of cortical or subependymal tubers and white matter abnormalities are the common radiologic findings, these will give strong evidence for suspecting tuberous sclerosis. accurate imaging differentiation of diagnosis and localization of tubers and is helpful for treatment.

Isolation of Enterococcus spp. in various clinical sample and their antimicrobial resistant pattern with MIC of vancomycin in patient attending tertiary care centre, RIMS, Ranchi, Jharkhand

Introduction- Enterococci are part of normal intestinal flora of humans and animals but have also emerged as important pathogens responsible for serious infections in hospital and community acquired infections.it is second most common cause of nosocomial infections in gastrointestinal tract, wound and genitourinary tract. To process all the clinicalAim- samples from various department in our hospital, for isolation of Enterococci spp. To speciate the isolates & to have resistance pattern of the isolates of vancomycin total 926 sample were collected from both outMaterial & Methods- patients and in patient in all clinical departments and transported to microbiology laboratory. specimens were processed by inoculating on to blood agar, MacConkey Agar, nutrient agar, potassium tellurite agar and incubated at 37°C for24-48 hr. Enterococci were identified by their typical arrangement in and salt tolerance test Gram stain, bile esculin test and biochemical tests. Antimicrobial susceptibility patterns were determined by performing Kirby-Bauer disc diffusion method and Minimum inhibitory concentration (MIC) values were identified by tube dilution methods. Result- a total of 926 sample, 645 (69.72%) were culture positive and 281 (30.28%) were culture negative. Among 645 culture positive cases, 81(12.55%) were Enterococcus faecalis. Antimicrobial susceptibility & MIC done as per standard protocols. The E. Faecalis showed 99% sensitive to Vancomycin. the resistance to vancomycin was 1% & further confirmed by MIC via tube dilution methods. In which MIC was ?32 ?g/ml in one isolate. About 8 of Enterococcal strains showed MIC of 0.0125?g/ml. species level identification of Enterococcus is important forConclusions- epidemiological study and also for analysis of drug resistant pattern. Effective detection of vancomycin resistance helps in reducing the morbidity and mortality of VRE in hospitalized patients

Molecular Characterization and Management of Congenital Hyperinsulinism: A Tertiary Centre Experience

Background: There is limited data from India regarding medical management of congenital hyperinsulinism (CHI). Objective: To study the molecular diagnosis, medical management and outcomes of children with CHI. Study design: Ambispective. Participants: Children with CHI admitted in from December, 2011 till March, 2020 at a tertiary care referral hospital. Outcomes: Clinical and genetic profile, treatment, and response Results: 42 children with a median age of 3 days (range 1 day to 6 years) were enrolled, of which 23 (54.7%) were diazoxideresponsive. Mutations were identified in 28 out of 41 (68.2%) patients. The commonest gene affected was ABCC8 in 22 patients. The pathogenic variant c.331G>A in ABCC8 gene was identified in 6 unrelated cases from one community. Good response to daily octreotide was seen in 13 of the 19 (68.4%) diazoxide-unresponsive patients. Monthly long-acting octreotide was initiated and daily octreotide could be stopped or tapered in 9 patients. Sirolimus was tried with variable response in 6 patients but was discontinued in 5 due to adverse effects. Four patients had focal CHI, of which one underwent partial pancreatic resection. The disease severity reduced with age and neurodevelopment was good in the patients with identifiable genetic defects who were optimally managed. Conclusions: Medical management of CHI is effective, if compliance can be ensured, with good quality of life and neurological outcomes.

CYTOLOGICAL EVALUATION OF NECK LYMPH NODES FOR METASTATIC DISEASE

Background: Fine needle aspiration cytology (FNAC) is a simple, rapid and cost effective procedure with minimal complications for evaluating enlarged neck nodes, but also gives clue. Neck lymph nodes are a common site of metastasis for various carcinomas, usually from the upper aerodigestive tract and salivary gland or carcinoma of unknown primary. Objectives: To study different cytomorphological patterns of metastatic neck nodes. To evaluate the diagnostic utility of FNAC in diagnosis of metastatic lesions of lymph node. Methods: It is a one year prospective study comprised of all aspirates 139 lymphnodes of 968 patients. FNACs conducted in the Department of Pathology, Vydehi Institute of Medical Sciences, Bangalore, between January 2019 to December 2019. A total of 70 out of 139 peripheral neck nodes in patients diagnosed with metastatic neck lymph node on FNAC were included in the study. Results: Out of 70 cases included in our study, metastasis to the neck lymph nodes were most common in the age group 51 to 60 years (38.6%) followed by 61 to 70 years (28.6%). Male preponderance was noted with male to female ratio of 1.7:1. On cytological examination, squamous cell carcinoma was found to be the most common tumor metastasizing to the neck nodes, accounting for 37 (52.9%) cases followed by each 10 (14.3%) cases each of undifferentiated carcinoma and thyroid carcinoma, 9 (12.9%) cases of adenocarcinoma, 3 (4.3%) cases of parotid gland carcinoma and 1 (1.4%) case of germ cell tumor of testis. Conclusion: FNAC is an early and reliable tool for the diagnosis of metastatic neck nodes. Any enlarged neck node should be investigated to rule out metastasis

Effect of low intensity ultra sound on bone regeneration and healing: a systematic review

ABSTRACT Objective: Low Intensity Pulsed Ultra Sound (LIPUS) is found to have stimulatory effect on bone healing and regeneration. This review aimed to assess whether LIPUS enhances bone regeneration and healing in terms of efficiency in improving clinical, radiographic, histologic parameters or serum and tissue biomarkers. Methods: A comprehensive search based on PRISMA guidelines with pre-determined eligibility criteria was conducted to identify randomized controlled clinical trials evaluating effectiveness of Low intensity pulsed ultrasound in bone regeneration and healing. The title and abstract of the entries in all languages yielded from the PubMed, Google scholar and Cochrane library were screened. Results: 14 eligible Randomized controlled trials testing the effectiveness of LIPUS was evaluated. More heterogeneity was seen in the screened studies with respect to sample characteristics, type of bone and outcome measures. The studies that screened histological parameters state that LIPUS is significantly beneficial than control. In terms of time for radiographic union, most of the studies stated that LIPUS was more effective than control but numberof studies are very few. Whereas studies which evaluated parameters such as healing time and radiographic union were showing highly inconsistent results regarding effectiveness of LIPUS. Conclusion: This review cannot give a definitive conclusion that LIPUS is effective in bone healing with respect to clinical parameters but a positive influence on radiographical and histological parameters in bone healing and regeneration is promising to pursue future research.

Molecular insights into the role of genetic determinants of congenital hypothyroidism

In our previous studies, we have demonstrated the association of certain variants of the thyroid-stimulating hormone receptor (TSHR), thyroid peroxidase (TPO), and thyroglobulin (TG) genes with congenital hypothyroidism. Herein, we explored the mechanistic basis for this association using different in silico tools. The mRNA 3'-untranslated region (3'-UTR) plays key roles in gene expression at the post-transcriptional level. In TSHR variants (rs2268477, rs7144481, and rs17630128), the binding affinity of microRNAs (miRs) (hsa-miR-154-5p, hsa-miR-376a-2-5p, hsa-miR-3935, hsa-miR-4280, and hsa-miR-6858-3p) to the 3'-UTR is disrupted, affecting post-transcriptional gene regulation. TPO and TG are the two key proteins necessary for the biosynthesis of thyroid hormones in the presence of iodide and H2O2. Reduced stability of these proteins leads to aberrant biosynthesis of thyroid hormones. Compared to the wild-type TPO protein, the p.S398T variant was found to exhibit less stability and significant rearrangements of intra-atomic bonds affecting the stoichiometry and substrate binding (binding energies, ΔG of wild-type vs. mutant: ‒15 vs. ‒13.8 kcal/mol; and dissociation constant, Kd of wild-type vs. mutant: 7.2E-12 vs. 7.0E-11 M). The missense mutations p.G653D and p.R1999W on the TG protein showed altered ΔG (0.24 kcal/mol and 0.79 kcal/mol, respectively). In conclusion, an in silico analysis of TSHR genetic variants in the 3'-UTR showed that they alter the binding affinities of different miRs. The TPO protein structure and mutant protein complex (p.S398T) are less stable, with potentially deleterious effects. A structural and energy analysis showed that TG mutations (p.G653D and p.R1999W) reduce the stability of the TG protein and affect its structure-functional relationship.

Diabetes Mellitus and Peripheral Vascular Disease

Chronic complications or the long-term side effects ofdiabetes mellitus includes microvascular complications whichaffects smaller blood vessels such as retinopathy, nephropathy,neuropathy and macrovascular complications which affectslarger blood vessels supplying the heart, brain, and extremities.Prevalence of Peripheral Vascular Disease (PVD) in diabetesranges between 20% and 30%. Endothelial cell dysfunction,vascular smooth muscle cell dysfunction, inflammation,impaired platelet function and abnormal coagulation are theother key factors in progression of PVD in diabetes. AnkleBrachial Index can be used as a screening tool at regularintervals. Apart from the intensified multifactorial treatmentof all modifiable risk factors, intensive therapy targetedat glycemic control and other modifiable cardiovascularrisk factor is needed to prevent micro and macro vascularcomplications of diabetes, especially PVD.

A comparative study between nifedipine and isoxsuprine in the suppression of preterm labor pain

Background: A prospective study was conducted to compare the effectiveness of Nifedipine and Isoxsuprine in suppression of preterm labour pain as tocolytics drug. As preterm labour pain is major contributor for perinatal morbidity and mortality. The aims of this study were to assess the effect of nifedipine and isoxsuprine in threatened preterm labour with the aim of preventing preterm birth and its sequelae.Methods: This study was conducted on 100 patients coming to Pannadhay Rajkiya Mahila Chikitsalaya, RNT Medical College, Udaipur and attending OPD and IPD with complain of uterine contractions between 28-36 weeks of gestation.Results: Nifedipine was more effective than isoxsuprine hydrochloride as tocolytic agent.Conclusions: There is high incidence of preterm labour in India which leads to neonatal morbidity and mortality. Nifedipine is a better tocolytic drug compared to isoxsuprine hydrochloride.

​Screening for Peripheral Vascular Disease among Type 2 Diabetes Patients of Lower Socio Economic Status using Ankle Brachial Index - A Descriptive Cross Sectional Study

Introduction: Diabetes mellitus is one of the key importantnon-communicable diseases of this century in terms ofmortality and prevalence. Peripheral Vascular Disease (PVD)is one of the most common macrovascular complications ofType II DM. PVD in risky cases exhibits as claudication organgrene, but in maximum cases, manifests hidden symptoms.Early detection of vascular changes helps in effective handlingof Diabetes and its complications. Study objectives were toassess Ankle Brachial Index in all asymptomatic vasculopathyin type2 diabetic patients of low socio-economic status usinga hand-held doppler and to correlate the findings of AnkleBrachial Index with PVD.Material and methods: A descriptive cross sectional studydone among the patients with asymptomatic vasculopathyin Type 2 diabetes mellitus patients coming to outpatientdepartment as well as admitted as inpatients in Shri SathyaSai Medical College and Research Centre, Ammapettai,Tamilnadu, India. The study duration was 18 months. Samplesize was calculated to be 130.Results: In the study population of 130, using the anklebrachial index, 110 (84.6%) were normal (1 and above). 11(8.5%) and 9 (6.9%) were having asymptomatic claudication(0.9-0.99) and claudication (<0.9) respectively. The prevalenceof PVD is 15.4% in the study population.Conclusion: Ankle Brachial Index is a simple, easy toperform, rapid, reliable and accurate test which can beperformed especially among the high risk groups.

Solid lipid nanoparticles: Preparation techniques, their characterization, and an update on recent studies

Solid lipid nanoparticles (SLNs) have emerged as a remarkable nanocolloidal system for drug delivery. This reviewpresents contemporary information regarding various aspects about SLNs, i.e., SLN morphology, structural features,preparatory methods, and their characterizations. This carrier system allows advancing the therapeutic efficacy ofdrugs belonging to several categories. The present uses of SLNs include cancer therapy, infectious conditions, diabetes,central nervous system disorders, cardiovascular disorders, cosmeceuticals, and others. SLNs facilitate improved thepharmacokinetics and modify the drug releases. The prospect of surface modification, enhanced permeation againstvarious biological barriers, the ability to resist chemical degradation, and the possibility of encapsulation of twoor more therapeutic agents simultaneously has gained attention for SLNs universally. Simultaneously, this reviewemphasizes on recent research trends pertaining to this carrier system.

Prospective study of complications of first trimester medical termination of pregnancy at tertiary care center

Background: MTP (is common procedure done by obstetrician under certain circumstances as per MTP rules and guideline, but it has certain complication and data about complication are not fully available. The aims of this study are to analyse various complication and causes of this complication following MTP presenting at our hospital.Methods: This study was conducted in 100 patients coming to Pannadhay Rajkiya Mahila Chikitsalaya, RNT Medical college, Udaipur attending OPD (including emergency OPD) and IPD during August and September 2019 after MTP. This Study also included maternal mortality among all women participated in the study.Results: A total of 100 cases included in study attended OPD (including emergency OPD) and IPD during study period. All cases were eligible for inclusion in the study. Medical method of abortion (MMA) was the most common method of termination of pregnancy adopted by patient. Prolonged bleeding, anaemia and Incomplete abortion was the common complication related to MTP and manual vacuum aspiration was done in majority of cases to manage incomplete abortion in our hospital setting.Conclusions: The high rate of MTP related morbidity is due to induced abortion continue to be done at inappropriate places using inappropriate methods by person not eligible to do so.

T-cell lymphomas in a tertiary care center of Mangalore

Background: The clinicomorphology and immunohistochemical features of T-cell lymphomas have been documented. Aim: The aim of the study was to evaluate the spectrum of clincopathological features of T-cell lymphoma with immunohistochemistry correlation in a tertiary care center. Materials and Methods: The present study was conducted on 19 biopsy specimens received from the Department of Pathology, Kasturba Medical College, from referral hospitals of Mangalore city. Cases of nodal and extranodal T-cell lymphomas diagnosed between January 2012 and December 2015 were selected with evaluation of clinical data, histomorphological features, and immunophenotyping. Appropriate panel of antibodies was chosen after morphological evaluation of the cases. Results: Of the 19 cases of T-cell lymphomas, 14 were nodal disease and 5 were extranodal disease. Among the nodal lymphomas, five were primary peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS), four were cases of lymphoblastic lymphoma, three were cases of angioimmunoblastic T-cell lymphomas, and two were cases of anaplastic large-cell lymphoma anaplastic lymphoma kinase (ALK) negative. In extranodal disease, two were mycosis fungoides of skin, one case each of subcutaneous panniculitis-like T-cell lymphoma, T-cell lymphoblastic lymphoma of tonsil, and T-cell lymphoma of the stomach. Conclusions: The diagnosis and subclassification of PTCLs is necessary for therapeutic and prognostic purposes

Gingival Crevicular Blood in the Diagnosis of Blood Glucose Level

Introduction: The etiopathogenesis of diabetes mellitus ismulti-factorial & complex and appears to involve interactionsof various immunological, genetic and environmental factors1.The Diabetes mellitus is associated with increased bloodglucose level. It represent one of the major chronic healthproblem faced by the society today2. The aim of this study isto evaluate a quick, safe, noninvasive and painless method toscreen for diabetes during regular clinical examination usingself-monitoring glucometer.Material and Methods: 35 cases who were reported toPrimary health centre, sahdei buzurg for hematologicalexamination were selected for the study. Probing of gingivalsulcus was done using William’s WHO probe. Blood oozingfrom the sulcus was collected on the strip provided by theglucometer and blood glucose level was recorded. For control,finger prick capillary blood was collected and blood glucoselevel was analyzed. Statistical analysis was done usingPearson’s Correlation Coefficient.Result: The result revealed strong correlation betweengingival crevicular blood and peripheral capillary measuredblood glucose level.Conclusion: Gingival crevicular blood collected duringclinical examination may be an excellent painless source ofblood for glucometric analysis.

A rare case of ischaemic stroke following cervical spine manipulation in an adolescent girl

Stroke in children is associated with a multitude of risk factors compared to risk factors of adult stroke such as hypertension, diabetes or atherosclerosis. A 15-year adolescent girl presented with acute onset weakness involving right upper and lower limb. She complained of neck pain and fever 2 days before the onset of hemiparesis for which her parents took her to traditional healer who performed neck manipulation after which she developed vomiting, tingling numbness and weakness of right upper and lower limb. There was no history of preceding headache, ear discharge or any other contributory history. Clinical examination revealed Glasgow Come Scale 12/15, power of grade 2/5 in right upper limb and 3/5 in right lower limb, exaggerated deep reflexes, extensor plantar reflex, right sided ptosis and right sided upper motor neuron facial palsy. CT scan brain showed right cerebellar and occipital infarct with posterior inferior cerebellar artery territory involvement. MRI Brain and MR Angiogram showed wedge shaped infarct involving right posterior inferior cerebellum, inferior vermis, ventral aspect of superior medulla, paracentral pons, right cerebral peduncle, tectum of both halves of midbrain with no internal hemorrhage and no vessel abnormality and right vertebral artery was not visualized. Her coagulation profile and cardiac work up were normal. She was treated with antiplatelet drugs, anticoagulants and physiotherapy following which the child gradually improved over a period of one month. In this case, with a positive history of neck manipulation authors can conclude that the etiology of young stroke wasinduced byneck manipulation. This case has been reported to increase awareness about the ill effects of neck manipulation and counsel parents against performing such procedures for children. Early recognition of pediatric stroke is critical for immediate diagnosis, imaging and treatment with better outcomes.

The Distribution of the ABO and Rh (D) Blood Types in Type II Diabetes Mellitus Patients

Introduction: The etiopathogenesis of diabetes mellitus ismulti-factorial & complex and appears to involve interactionsof various immunological, genetic and environmental factors.Positive association with blood groups shows increasedsusceptibility and a negative association shows protectionagainst diabetes mellitus. Present study was conducted to findout a possible association between type II diabetes mellitus(DM) and ABO & Rh blood groups.Material and Methods: The study involved 313 patients whoreported to Haematology Laboratory for blood investigationsover a period of 5 months. On the basis of Random & FastingBlood Sugar levels, we made Group I (Diabetic patients) &Group II (Healthy controls). ABO & Rh blood grouping donefor both the groups.Results: AB & B blood group showed less commonassociation with diabetes mellitus. Diabetes mellitus (DM)were more associated with Blood group A, as compared tocontrols. Blood group O has same distribution among bothgroups. Diabetics has higher percentage than controls hadRh positive blood group (96.55% vs 94.69%), and diabeticsshowed less percentage of Rh negative blood group (3.44%vs 5.3%). Blood group B, AB and O were positive in higherpercentage among diabetics, and it was same in blood group A.Conclusion: According to Results, it has association betweenDM and Rh positive blood groups and between blood groupsB & AB it has negative association.

Evaluation of neo adjuvant chemotherapy response in patients with locally advanced breast cancer

Background:Carcinoma of the breast from the very beginning has been a feared disease. Advanced disease is treated by neoadjuvant chemotherapy (NACT). With this, a study was conducted to evaluate the pathologic response to NACT in locally advanced breast cancer.Methods:Study was conducted in GSL Medical College, approved by institutional ethics committee, females aged >18 years with locally advanced breast cancer were included in the study. Female <18 years and breast cancer male were not considered. The dimensions are marked and size of the lump compared before and after NACT. Chi-square test was used to find out the significance of study parameters; p<0.05 was considered statistically significant.Results:Total 110 patients were included in the study, mean age was50.63±10.76 years and 53% were in pre menopausal women. When pathological response was considered, 12.7% had complete response, 66.4% had partial response and 20.9% had no response to NACT; statistically there was significant difference between pre and post treatment tumor sizes (p<0.05).Conclusions: Most of the individuals belonged to premenopausal group. Tumour size showed significant decrease after NACT. The overall response rate (completeand partial) after NACTwas significant in our study group

Functional Outcome of Isolated Posterior Cruciate Ligament Avulsion Fractures Treated by Open Reduction and Internal Fixation

Isolated Posterior cruciate ligament (PCL) avulsion fractures are uncommon, but are complicated intra-articular fractures.1 In India due to high prevalence of motorcycle transportation, the cause of PCL avulsion fractures was predominantly motorcycle accidents, though sports accidents still remain the most common cause in world over. These injuries are quite often missed in the emergency department and are often neglected. In the long run they cause severe functional disability of the knee joint. There is no consensus concerning the optimal surgical treatment approach for these injuries. Hence, we aimed to study the functional and clinical outcome of isolated PCL avulsion fractures with open reduction and internal fixation.METHODSThis is a prospective study of 28 cases of isolated PCL tibial avulsion fractures, in patients aged between 22-38 years during the period 2014 - 2018 in our hospital. All were treated with open reduction and internal fixation with 4 mm cannulated cancellous screw and washer. Postoperatively, patient leg was immobilized in posterior POP slab for 2 weeks, allowing toe touch weight bearing. All patients were regularly followed-up at 2, 4, 6, 8, 10, and 12 weeks. The functional outcome is assessed by Lyndholm scoring at the end of 12 weeks.RESULTS98% of the cases have shown excellent results with good range of movement in the knee without pain and without knee instability. The other 2% of cases had mild knee arthrofibrosis and pain.CONCLUSIONSPCL Avulsion fractures are rarity but yet need to be managed surgically. Open reduction and internal fixation by Burks and Schaffer approach has resulted in excellent results and good functional outcome.