Strike Omicron before you Captures It !

Omicron is currently shaking the world to its core. The disease is mainly transmitted via the respiratory route when people inhale droplets and small airborne particles (that form an aerosol) that infected people exhale as they breathe, talk, cough, sneeze, or sing. “UK becomes first country in Europe to pass 1,50,000 COVID deaths Omicron clouds forecasts for Covid end game.Omicron is a variant of nSARS-CoV-2 that has been identified initially in COVID19 patients in Botswana and South Africa. The chief of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, has said that the combination of Delta and Omicron variants of coronavirus is driving a tsunami of COVID-19 cases. The statement came as record new cases were reported from the United States and countries across Europe. France recorded the highest ever daily numbers in Europe for the second consecutive day, at 208,000 new cases.Vaccines offer strong protection from serious illness.

Outcomes of the Perplexed Surgical Management of Retinal Detachment in Eyes with Coloboma

Purpose@#To determine the anatomical and visual outcomes of retinal detachment in eyes with chorioretinal coloboma managed by pars plana vitrectomy, endolaser photocoagulation and silicone oil (SO) tamponade. @*Methods@#Retrospective review of 29 eyes of 29 patients with retinal detachment associated with chorioretinal coloboma. All the cases were managed by vitrectomy procedures concluding with SO tamponade. Encircling band was placed based on pre-operative evaluation and/or surgeon’s discretion. Endolaser photocoagulation was applied around the peripheral retina, all around the peripheral breaks and around the colobomatous area. The outcome measures were evaluated with regard to functional and anatomical success. @*Results@#The average age at the time of surgery was 21.76 ± 9.58 years (range, 10–50 years). The mean follow-up duration was 12.28 ± 4.8 months (range, 6–24 months). Primary attached retina was obtained in 21 / 29 (72.4%) eyes after single surgery. Re-detachment in 8 / 29 (27.6%) eyes which required revision surgery was the most frequent postoperative complication followed by raised intraocular pressure in 4 / 29 (13.8%) with SO in situ. Out of 29 eyes, 23 were followed up after the removal of SO. The mean duration of SO removal was 7.91 ± 3.9 months (range, 4–18 months). Implantation of encircling band, lens removal and cryotherapy provided no added advantage. At the final examination, improvement in vision was observed in 21 (72.4%) eyes and the anatomical attachment of the retina was attained in 27 (93.1%) eyes. @*Conclusions@#Complete pars plana vitrectomy, endolaser photocoagulation along with SO tamponade is effective for retinal detachment associated with chorioretinal coloboma. This technique improves the anatomical outcome and helps in regaining significant visual acuity.

Adding bit of esthetics with science modification of batwing mastopexy for breast conservation in a young patient with giant fibroadenoma breast

A 19-year-old girl presented with a lump in her right breast and with a history of surgery for the similar complaint 3 years back. Ultrasound was suggestive of benign solitary lesion of size 16 cm × 10 cm. Core biopsy was suggestive of phyllodes tumor, and the histopathology report of previous surgery was also suggestive of phyllodes tumor. Wide excision of the tumor and reconstruction was done with batwing mastopexy and with a slight modification of the described technique so that to avoid contralateral reduction mammoplasty in a young unmarried girl. Postoperative histopathology was suggestive of fibroadenoma measuring 15 cm × 8 cm with all margins free of tumor, and it is probably one of the biggest fibroadenomas reported so far. On follow-up, no significant disparity noted between the appearances of both breasts

Role of ultrasonographic optic nerve sheath diameter in the diagnosis and follow-up of papilledema and its correlation with Frisén's severity grading

Purpose: The aim of this study was to compare the ultrasonographic optic nerve sheath diameter (ONSD) in different grades of papilledema and in controls and to evaluate ONSD in atrophic papilledema/optic atrophy when raised ICP was suspected. Methods: Prospective cross-sectional case–control study. Following an ocular examination, papilledema was graded clinically using modified Frisén's grading. An ultrasonographic cross section of the retrobulbar optic nerve was obtained with a posterior transverse scan. Independent t-test and analysis of variance were the statistical tools used in the study. Results: The study included 55 cases and 55 age- and gender-matched controls; mean (± standard deviation) age was 37.17 (±11.25) years and male: female ratio was 49:61. There was a statistically significant difference in the mean ultrasonographic ONSD between cases [4.89 (±0.65) mm] and controls [3.12 (±0.22) mm] (P < 0.001). There was a significant difference in the mean ONSD across Frisén's grades of papilledema (P < 0.001). The mean ONSD in atrophic papilledema was 6.2 (±0.75) mm. Conclusion: In the presence of symptoms, ultrasonographic ONSD >4 mm is diagnostic of papilledema. Ultrasonographic ONSD correlates well with the severity of papilledema and can be used to follow-up patients with chronically elevated ICP. It is useful in detecting raised ICP in the presence of optic atrophy and to distinguish true papilledema from pseudopapilledema.

Clinical predictors of axillary lymph node metastasis in early breast cancer in Indian patients

Background: Surgical dissection is the accepted mode of staging the axilla in breast cancer. Proper prediction of axillary node positivity can help towards stratifying patients. The primary objective of the study was to assess the clinical factors influencing pathological axillary lymph node positivity in early carcinoma breast.Methods: This was a retrospective study, conducted at a tertiary cancer centre. Case records of all the patients with invasive breast cancer which are clinical T1 and T2 and either N0 or NI, from January 2011 to October 2014 were analysed. Clinical profile of the patient including age, BMI, comorbid, menstrual history, family history, symptoms, site of the lesion, size, single or multi centric origin were analysed.Results: Total of 608 patients of early breast cancer analysed of which 248 had pathological nodal positivity. The age group of 51 to 75 years, BMI ≥30, pre-menopausal patients had significant positive predictive value when compared to post-menopausal. Tumours in lower outer quadrant, central sector and multiple tumours also had positive predictive value. Clinical T2 when compared to clinical T1 stage and MRM when compared to BCS had significant positive predictive value.Conclusions: To conclude in present study age of the patient and clinical location of the tumour and surgery performed emerged as significant independent predictive factors of positive lymph node. Prospective studies are required to further prove the significance of these factors.

Screening and diagnosis of gestational diabetes mellitus by IADPSG criteria

Background: GDM is a complex clinical entity and its screening, diagnosis, and management warrants attention. With this issue in mind, we aimed to study the prevalence of gestational diabetes mellitus in the antenatal group of patients attending tertiary hospital in New Delhi and its association with maternal outcome.Methods: 300 pregnant patients were enrolled in the first trimester and RBS (random blood sugar) was done. Those who had RBS >200mg/dl were labelled as overt diabetes and excluded from the study. The patients who were screened negative in phase 1 of screening were subjected to the next phase of screening at 24-28 weeks of gestation with 2-hour 75g OGTT using IADPSG criteria. Those who were diagnosed as GDM were followed in the antepartum, intrapartum and postpartum period.Results: The prevalence of overt diabetes and GDM in the study population is 1.33% and 13.33%. The prevalence of gestational hypertension, pre-eclampsia, chronic hypertension, polyhydramnios was 15%, 5%, 5%, 7.5% respectively. Normal and instrumental vaginal delivery was in 50 %, 5% patients respectively and 45 % had the caesarean section.Conclusions: The single step OGTT with lower threshold value cut-offs and single abnormal value for the diagnosis of GDM as advocated by IADPSG seem to be effective as it helps to screen and diagnose GDM at the same time as a single step procedure and thus more cost-effective.

Bleeding Jejunal Metastases Arising From Primary Alveolar Soft Part Sarcoma Of Thigh

Alveolar soft part sarcoma (ASPS) is a rare tumor (0.5–1% of sarcomas) of unknown etiology with a highly characteristic morphology. It tends to occur more often in the younger age group with a predilection for the female sex. Prognosis is generally poor and it often presents with late metastases. Here, we report the case of a 48-year-old female, who presented to the emergency department with a complaint of giddiness and melena. She was a known case of sarcoma ASPS left thigh with pulmonary secondaries. On evaluation, a bleeding tumor in the upper jejunum was found on upper GI endoscopy. As the patient’s hemodynamics were unstable, she had to be operated without further imaging. Post-operative period was uneventful

Gastrointestinal Mixed Neuroendocrine Carcinoma: Case Reports And Review Of Literature

Mixed adenoneuroendocrine carcinoma (MANEC) is a rare and relatively newer entity and classified into a separate category by the WHO 2010 Classification of Tumors. Accordingly, due to its rarity of diagnosis, further oncologic management is a challenge. They contain an adenocarcinoma part and a neuroendocrine part and are further classified based on grades. We present case series with a histological diagnosis of MANEC, its management, and clinical behavior in the follow-up period. Optimum mode of the management of these tumors is yet to be proposed, as these groups of tumors are highly aggressive and associated with poor prognosis.

Evaluation of internal echogenic pattern of masseter in subjects with myofascial pain/ myositis, oral submucous fibrosis, chewers, bruxers and healthy individuals- a preliminary ultrasonographic study

Statement of the Problem: The masseter is generally involved in myofascial pain, myositis, oral submucous fibrosis [OSMF], bruxism, and in subjects with habitual tobacco/arecanut chewing. In all the above conditions, changes in the internal echogenic pattern on ultrasonography of the muscle may be observed

Purpose: The present study aimed at evaluating the internal echogenic pattern of masseter by ultrasonography in subjects with various conditions affecting master muscle

Materials and Method: The study subjects were categorized into 5 groups consisting of 20 subjects each with the following conditions; Group 1: myofascial pain or myositis, Group 2: oral submucous fibrosis [OSMF], Group 3: habitual chewing of tobacco/arecanut without OSMF, Group 4: bruxism. Group 5 consisted of 20 healthy subjects. An ultrasonographic examination of masseter was performed in all subjects and the echogenic pattern was classified into Types I, II and III. The images were examined by two observers and inter-observer variability was assessed. Differences in internal echogenic pattern between study groups and control group was evaluated using Chi- square test

Results: A good inter observer agreement was noted [k value= 0.8]. An equal distribution of Types II and III echogenic pattern was noted in myofascial pain/myositis group. Type II was predominant in subjects with OSMF, habitual tobacco/arecanut chewing and bruxism. Type I was predominant in controls. The echogenic pattern differed significantly from controls in subjects with myofascial pain/myositis and OSMF [p=0.00001*, 0.0237* respectively], whereas in subjects with habitual tobacco/arecanut chewing and bruxism, it did not differ significantly from controls [p=0.2482, 0.1223 respectively]

Conclusion: Ultrasonographic examination of the echogenic pattern may help in understanding the nature of the disease process affecting the masseter muscle in various conditions

Pattern of drug use in the management of psoriasis in a tertiary care hospital: a prospective study.

Background: Psoriasis is a chronic skin disease, characterized by chronic and recurrent scaly plaques with itching. The treatment modalities for psoriasis include topical, systemic, and phototherapy (PT). The pattern of therapy may vary depending upon the type, severity, and duration of the disease. As there are few reports in the Indian literature regarding the pattern of drug use in psoriasis and evaluating the efficacy and patient compliance to treatment, the present study was conducted. Methods: This was a prospective, observational study conducted on 121 newly diagnosed and untreated patients with psoriasis, who attended Dermatology outpatient department of a tertiary care hospital. The severity of the disease was assessed by baseline psoriasis area severity index (PASI) score. Most of the patients were treated with topical therapy consisting of glucocorticoids (GC) monotherapy or combination with, salicylic acid, calcitriol and coal tar. Systemic therapy and PT were considered only for severe cases of psoriasis with baseline PASI score >4. The patients were monitored every 2 weeks for 3 months. Results: The topical medications induced effective resolution of lesions in most of the patients, along with adequate symptomatic relief. The response to GC monotherapy was found significant (90.47%; p<0.001) and there was 76.13% decrease in PASI score in chronic plaque psoriasis, indicating significant improvement (p<0.001) after 12 weeks of therapy. More than 94% of study patients showed good compliance to medications and only 0.27% showed poor compliance, whereas the other patients showed a moderate compliance of 80-95%. Conclusions: Most of the patients with psoriasis can be effectively treated with topical medications, and additional systemic and/or PT may be required only for severe cases of chronic plaque psoriasis with baseline score >4. Regular follow-up is required not only to monitor the treatment response, but also to ensure good patient compliance by proper counseling.

Clostridium difficile infections in HIV-positive patients with diarrhoea.

Background. Patients with HIV/AIDS are at a high risk of being infected with toxin-producing strains of Clostridium difficile (C. difficile) because of frequent hospitalization, exposure to antibiotics and antibiotic prophylaxis for opportunistic infections. There are little data from India on the prevalence of C. difficile infection in such patients. Methods. We assessed the occurrence of C. difficile infections in HIV-positive patients with diarrhoea by looking for the presence of its toxin as well as by culturing. Enzyme immunoassay (EIA, Premier toxins A and B; Meridian Diagnostic Inc.) was used to detect toxin from 237 fresh stool samples collected from HIV-positive patients with diarrhoea. Culture was done on cycloserine–cefoxitin–fructose agar and brain– heart infusion agar. Results. C. difficile was found in 12 of 237 (5.1%, 95% CI 2.64%–8.68%) HIV-positive patients with diarrhoea (9 patients were positive by EIA and 3 by culture). The presence of C. difficile in patients who had received antiretroviral therapy (7/66 [10.6%]) was significantly higher (p<0.016) compared with those who had not (5/171 [3%]). Of the 12 patients positive for C. difficile, 7 were on antiretroviral therapy for a mean (SD) of 34.4 months with mean CD4+ count of 186 (98.81) cells/cmm and 5 patients were anti-retroviral-naïve with mean CD4+ count of 181 (68.7) cells/cmm. All the 12 patients were on antibiotics for previous 2 months and 4 of 12 had been hospitalized in the previous 30 days. Conclusion. C. difficile infections occurred more frequently in patients who had received antiretroviral therapy. Our study population had a lower frequency of C. difficile infections compared to previous studies.

Retrospective study of common prevalent risk factors among female patients presented with acute coronary syndrome.

Background and Objective : Acute coronary syndrome (ACS) is characterized by classical history of ischaemic chest pain, apprehension and sweating with definite Electro-Cardio gram (ECG) evidence or cardiac marker of ischaemia. The risk factors for Coronary Artery Disease (CAD) are modifiable and non-modifiable. CAD is a major cause of disability and the leading cause of death in women. The objective of our study was to assess the impact of various risk factors in women presented with ACS. Method: A total of 100 female patients of ACS and twenty healthy females were taken as control. The mean age of women presented with ACS was 62.62 years and all have attained menopause. Result: The prevalence of major risk factors of ACS in women are hypertension (78%), stress (74%), obesity (46%), sedentary habits (38%), genetic predisposition (36%), diabetes (32%) and tobacco use (18%),higher socio-economic status (74%). Significantly (P <0.05) high levels of total cholesterol, triglycerides along with reduced High Density Lipid (HDL). Conclusion: The prevalence of C - reactive protein (CRP) Positivity (>6 mg/L) is significant in women with (92%) as compared to healthy women (20%).

Uterine artery embolization: exploring new dimensions in obstetric emergencies

The role of transcatheter arterial embolization in the management of obstetric emergencies is relatively new and not so commonly used. In the following series, the efficacy of this technique in situations such as scar site ectopic pregnancy, antepartum and postpartum obstetric hemorrhage, especially in the presence of coagulation derangement is presented

Synthesis and Evaluation of new Ethyl N-[(Z)-(2-Oxo-5-Sulfamoyl-Indolin-3-Ylidene) Amino] Carbamate Derivatives for their Antimicrobial and Anti-inflammatory Activity.

In view of various biological activities and enormous importance of indoles, isatins and their derivatives, it was our interest to synthesize and characterize some new 5-Sulfamoyl Isatin derivatives and evaluate them for antimicrobial and anti-inflammatory activity. An appropriate quantity of isatin hydrazone was heated under reflux with ethylchloroformate to give ethyl n-[(z)-(2-oxo-5-sulfamoyl-indolin-3-ylidene)amino]carbamate which was then heated under reflux with various primary amines to give ethyl n-[(z)-(2-oxo-5-sulfamoyl-indolin-3- ylidene) amino]carbamate derivatives. The intermediates and final compounds were purified and their chemical structures have been confirmed by IR, 1H NMR, and Mass spectral data. All the synthesized compounds were screened for antibacterial activity against B. subtilis, B.cereus, S. epidermidis, S. typhi, P. aeruginosa and K. pneumoniae, antifungal activity against A. flavus, F. oxysporium and P. notatum and anti-inflammatory activity using carrageenan induced rat paw edema model. Most of the compounds tested have shown promising activities when compared with the standard drugs.

Indacaterol and salmeterol in COPD patients: a comparative study of efficacy and safety.

Background: Chronic obstructive pulmonary disease (COPD) is an airway disorder characterized by airflow limitation that is not fully reversible. Indacaterol is a novel, inhaled, once-daily, ultra-long-acting β2-agonist bronchodilator recently approved in India for the treatment of chronic obstructive pulmonary disease (COPD). The aim of the present study was to investigate the efficacy and safety of indacaterol compared to twice-daily β2-agonist, salmeterol, as an active control. Methods: The present study was open, randomized parallel group comparison of two active treatment groups over a 12 week period. A total of 60 patients with moderate-to-severe COPD were randomised to treatment either with indacaterol (150 μg once daily) or with salmeterol (50 μg twice daily) and 51 (85%) patients completed the study. The efficacy parameters were change in FEV1, health related quality of life by measuring St George’s Respiratory Questionnaire (SGRQ) total score and severity of dyspnoea as measured by Transition Dyspnoea Index (TDI) score which were assessed at baseline first and at weeks 4, 8 and 12. Results: Indacaterol increased FEV1 at week 4 by 50 ml, at week 8 and at week 12 by 60 ml over salmeterol and the increase was highly significant (p<0.001) at all stages of the study. Both treatments improved health status (SGRQ total score) and dyspnoea (TDI score), with differences between them favouring indacaterol. Safety profiles were similar across the treatment groups, and both indacaterol and salmeterol were well tolerated without any severe adverse events. Conclusions: Once-daily treatment with 150 μg indacaterol had a significant and clinically relevant bronchodilator effect and improved health status and dyspnoea to a greater extent than twice-daily 50 μg salmeterol. Indacaterol should prove a useful addition in the treatment of patients with COPD.

Quantitative determination of Asenapine in both bulk and formulations using neutralization titrations.

Asenapine is used in the treatment of schizophrenia disease.Asenapine mainly control the psychotic symptoms’ mainly antagonist to various receptors like, serotonin (5-HT1A, 5- HT1B,5-HT2A,5-HT2B,),histamine, and dopamine(D1,D2,D3,D4) receptors. It is also lower affinity towards muscaranic and acetylcholine receptors. In the present study, simple titrimetric method was developed. Respective quantities of Asenapine were taken in aqueous methanol titrated against 0.1N sodium hydroxide acid and 0.1N potassium hydroxide acid using phenolphthalein as an indicators for neutralization titration. This method were found to be sensitive and inexpensive, do not require any sample processing steps and can be utilized for estimation of asenapine in bulk and formulations.

Quantitative determination of Cimetidine in both bulk and formulations using neutralization titrations.

Cimetidine is the selective H2 receptor antagonist and inhibits the secretion of hydrochloric acid in the stomach. In the present study, simple titrimetric method was developed. Respective quantities of Cimetidine were taken in aqueous methanol and acetic acid titrated against 0.1N hydrochloric acid and 0.1N perchloric acid using methyl orange and crystal violet as indicators for neutralization and non-aqueous titrations. All the titrations are carried out by running simultaneous blank determinations. The final titer values are subtracted from blank to get actual amount of acid consumed was determined. These methods were found to be sensitive and inexpensive, do not require any sample processing steps and can be utilized for estimation of cimetidine in bulk and formulations.