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A 60-year-old male patient who presented with generalized weakness and low-grade fever was diagnosed to be human immunodeficiency virus (HIV) positive with a CD4 count of 17. Routine laboratory investigations revealed pancytopenia. Serum cytomegalovirus (CMV) DNA polymerase chain reaction (PCR) was positive and fundoscopy showed CMV retinitis in the right eye. The patient was started on tablet valganciclovir. After 2 weeks, the patient was brought back in an altered sensorium. He was found to have hyponatremia which was corrected. He was started on antiretroviral therapy and tablet valganciclovir was continued. The patient came back again after one and a half months with a urinary tract infection and fissure-in-ano. He was found to have severe neutropenia. Valganciclovir was stopped. He was started on injection granulocyte colony-stimulating factor. The patient clinically improved and his hematological parameters became normal. Patients having HIV and CMV co-infection with pre-existing pancytopenia have to be closely monitored as the medicines used for treatment can exacerbate the existing conditions.
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Alambusha (Biophytum sensitivum) belonging to the family oxalidaceae, commonly known as Mukkutti, is mostly found in marshy regions of south India, abundantly seen during rainy season. It is known as the “Small Tree Plant” with sensitive leaflets and bright yellow circular small flowers resembles like a tree in its texture and looks. The phytochemistry of B.sensitivum showed a wide range of chemical compounds, such as, two biflavones, three flavonoids and two acids. The plant is described in Ayurvedic classics, by Nighantu Acharyas, as Krimighna herb. The plant, is traditionally believed to exhibit antioxidants, anti-inflammatory and anti-tumor activity, radioprotection, immune-modulation, antibacterial, wound-healing, hypoglycemic actions. B.sensitivum has been used as traditional medicine for several purposes such as expectorant, stimulant, and tonic. It is recommended to be used in the treatment of stomach ache, asthma, treating insomnia, convulsions, cramps, chest complaints, inflammations, wound infections, tumors, and remedying chronic skin diseases. In the present review, all the available sources regarding the plant B. sensitivum was highlighted in a bird eye view
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Justification: When developmental dysplasia of the hip (DDH) is diagnosed during infancy, conservative management is often successful, with good long-term outcomes. In India, DDH is often not diagnosed until walking age and there are limited guidelines for its screening. Process: A multidisciplinary Expert Group consisting of members of the Paediatric Orthopaedic Society of India, Indian Academy of Pediatrics, National Neonatology Forum of India, Indian Radiological and Imaging Association, Indian Federation of Ultrasound in Medicine and Biology, Federation of Obstetric and Gynaecological Societies of India, and Indian Orthopaedic Association worked collaboratively to develop surveillance guidelines for DDH. Objectives: To enhance the early detection rate of DDH in India through development and implementation of a standardized surveillance care pathway, thus reducing the burden of late-presenting DDH. Recommendations: Routine clinical hip examinations must be performed on all infants at birth and during immunization visits at these approximate time points: 6, 10, and 14 weeks; 6, 9, 12, 15, and 18 months of age. Assessments include Ortolani and Barlow tests for infants <14 weeks; limited hip abduction and leg length discrepancy for infants >14 weeks; and evaluation of limp in walking children. If clinical examination is abnormal or inconclusive, referral to orthopedics for further evaluation and management is recommended. In infants younger than 6 weeks with positive Barlow test but negative Ortolani test, hip ultrasound is recommended at 6 weeks of age. Infants must also be screened for DDH risk factors: breech presentation, family history of DDH, unsafe hip swaddling, and hip instability at any previous clinical examination. In infants with risk factors but normal clinical examination, further evaluation should include ultrasound taken no earlier than 6 weeks of age for infants younger than 14 weeks, ultrasound or X-ray for infants 14 weeks to 6 months of age, and X-ray for infants older than 6 months. Referral to an orthopedic surgeon is recommended if radiological tests are abnormal.
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Objective: To compare outcomes of preterm neonates born through assisted reproduction techniques (ART) and non-ART conception. Methods: This retrospective cohort study included very preterm neonates (26 weeks to 31 weeks) admitted to our neonatal unit over a six year period from 2014 to 2019. The primary outcome was composite adverse outcome of mortality or any of the major morbidities i.e., intraventricular hemorrhage (IVH) grade ?3, periventricular leukomalacia (PVL) grade ?2, bronchopulmonary dysplasia (BPD) at 36 weeks, and retinopathy of prematurity (ROP) requiring treatment. Results: Total of 759 neonates (253 in ART group, 506 in non-ART group) were included after propensity score matching for gestational age, sex, and small for gestational age (SGA). Neonates in ART group had similar rates of composite adverse outcome [aOR (95% CI) 0.86 (0.55 – 1.36)], mortality [0.93, (0.53- 1.64)] BPD [1.18, (0.37 – 3.76)]; ROP requiring treatment [ 0.49 (0.14-1.71], and other morbidities. Conclusion: Very preterm neonates born through ART were not at increased risk of adverse neonatal outcomes.
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Objective: The COVID-19 outbreak has wreaked havoc on India's economy. This article examines how India has dealt with all of the country's severe economic problems and how it has dealt with them through various government programmes. Methods: This research article based on secondary data. Different secondary sources, such as websites, government publications, journals, magazines, and newspaper articles, are preferred for acquiring information. As a result, the utilisation of a comprehensive Literature Review approach was used to make the current research signi?cant. Results: All economic activity was halted as a result of the shutdown, and individuals lost their employment. Manufacturing and service industries have completely shut down. In India, during COVID-19 pandemic worker migration had begun. The covid-19 epidemic had a signi?cant impact on every economic sector (tourist, retail, manufacturing, aviation, infrastructure, stock markets, and etc.). Due to the COVID-19 pandemic outbreak in the ?rst quarter of 2020-21, India's GDP growth rate fell to -24.38 percent. However, the government's ?scal policies and the Reserve Bank of India's monetary policies aid India's economic recovery. India attracts foreign direct investment because major corporations have lost faith in China, and all manufacturing activity has moved to another country. India has made a concerted effort to attract these countries. Conclusions: In this COVID-19 pandemic, India implemented a strict lockdown, which resulted in higher unemployment, lower GDP growth, and starving people migrating. India faced a critical scenario during COVID-19 due to a lack of health facilities. However, new concepts were explored during Covid -19 pandemic such as work from home, digital education, and a growth in social media marketing.
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BACKGROUND@#Previous studies have suggested that exposures to heavy metals (arsenic, cadmium, lead, and selenium) may be associated with differences in blood pressure. However, the findings of these studies have been inconsistent. This study was performed to examine the associations between urinary heavy metal concentrations and blood pressure among residents of four Asian countries (Bangladesh, Indonesia, Nepal, and Vietnam).@*METHODS@#This cross-sectional study examined 1899 adults in four Asian countries. Urinary concentrations of heavy metals were measured by inductively coupled plasma mass spectrometry. A questionnaire survey was administered regarding individual characteristics. Anthropometric measurements (height and weight) were performed. Systolic and diastolic blood pressures were measured after a short rest. Multiple linear regression models were applied to investigate associations between urinary heavy metal concentrations and blood pressure after adjustments for age, sex, and body mass index.@*RESULTS@#The geometric means of the urinary concentrations of arsenic, cadmium, lead, and selenium were 84.6, 0.885, 2.09, and 16.5 μg/g creatinine, respectively. The urinary arsenic concentrations were slightly higher than those typically reported in non-polluted populations, while urinary cadmium, lead, and selenium concentrations were equivalent or slightly lower. The urinary lead concentrations were positively associated with both systolic and diastolic blood pressure, but urinary selenium concentrations were negatively associated with them.@*CONCLUSIONS@#Variations in the urinary concentrations of lead and selenium were associated with blood pressure at low levels of exposure/intake.
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Adult , Female , Humans , Male , Middle Aged , Arsenic/urine , Bangladesh , Blood Pressure , Cadmium/urine , Cross-Sectional Studies , Environmental Exposure , Indonesia , Lead/urine , Linear Models , Metals, Heavy/urine , Nepal , Selenium/urine , VietnamABSTRACT
Undescended testis is one of the common disorders encountered in a male child. In nonpalpable testis, ultrasound often fails to locate the testis. Hence, diagnostic laparoscopy has recently replaced it in the management of nonpalpable testis. METHODSThis is a cross-sectional study conducted among all patients who presented between October 2018 and March 2020 with a nonpalpable testis and in whom ultrasound could not locate the testis. Analysis of ultrasound and diagnostic laparoscopy in nonpalpable testis was done. Statistical analysis was done by calculating accuracy, sensitivity, and specificity for selected tests. RESULTS20 patients were included in the study. Most of them (95%) presented after 1 year. Most cases were unilateral 80%; left-sided in 45%, right sided in 35%, and 4 (20%) were bilateral. In 25% cases, the testis was located at the deep inguinal ring, and in 70% cases, it was intra-abdominal, although in 2 cases the testes were tiny like a nubbin. In 1 case, the vessels and vas entered the deep inguinal ring; hence inguinal exploration was done; however, as only a nubbin was found on exploration, orchidectomy was done. In 1 patient inguinal exploration done, whereas other patients were managed laparoscopically. In 2 patients, laparoscopic orchidectomy and in others, laparoscopic-assisted orchiopexy were done. CONCLUSIONSLaparoscopy is superior to ultrasound because of increased sensitivity in localizing a nonpalpable testis, time- and cost-effectiveness, and diagnostic as well as therapeutic options.
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Background: Pediatric urolithiasis results in significant morbidity in later life. Incidence as well as site and chemical composition of calculi varies according to the changes in socio-economic conditions over time and the subsequent changes in dietary habits leading to a marked variation in the spectrum of urinary stone composition. To evaluate the spectrum of urinary stone composition in pediatric population from North-western India.Methods: This was a prospective observational study conducted between October 2013 and February 2019 which included pediatric patients with urolithiasis. Demographic and epidemiological characteristics including age, sex, geography, religion, socio-economic status, dietary habits were recorded. The location and sizes of stones were documented. The data was collected, analyzed and presented using summary statistics.Results: A total of 163 patients with urolithiasis were enrolled, of which 86 (53%) aged between 6 and 10 years, 49 (30%) aged between 11 and 14 years and 28 (17%) were aged between 0 and 5 years. The majority of patients were male (n=134; 82.21%). The most common location of the stone was urinary bladder (n=106; 65.03%) followed by kidney (n=33; 20.25%), urethra (n=16; 9.82%) and ureter (n=8; 4.91%). The upper tract (kidney and ureter) to the lower tract (bladder and urethra) stone ratio was 1:4. Stones with mixed composition were more than pure stones (73.62% versus 26.38%). The most common composition was the mixed stone of calcium oxalate, calcium phosphate and uric acid (n=36; 22.09%) followed by mixed stone of calcium oxalate monohydrate and dihydrate with uric acid (n=29; 17.79%), calcium oxalate and uric acid (n=25, 15.34%), calcium oxalate and calcium phosphate (n=20; 12.27%). Calcium oxalate was present in 80% of the stones, followed by uric acid in 7%, struvite in 6%, cystine in 3% and calcium phosphate in 2%.Conclusions: These results suggest that the prevalence of mixed stones with calcium oxalate as the predominant chemical component in the urinary stones of pediatric patients studied.
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Background: Epidermal inclusion cyst, smegma stones and urethral calculi of the penis are rare and may result as a late complication of hypospadias repair. This study reported the presentation and management of these late complications.Methods: A prospective observational study included male patients aged more than 6 years of age, who had undergone hypospadias repair 3-15 years back and presented with slow growing, non-tender, mobile, firm to hard swelling. Histopathological and radiographic examination were done and surgery was used for management of epidermal inclusion cyst, urethral calculi and smegma stone. Patients were followed up for one year, postoperatively.Results: Out of 15 patients, two (13.3%), four (26.7%) and nine (60%) patients were diagnosed with smegma stones, epidermal inclusion cyst and urethral calculi, respectively. The median (range) age of patients was 17 (8-30) years. Patients were presented with slow growing, non-tender, mobile swelling measuring from 1 cm x 3 cm to 2 cm x 1.5 cm. The average size of epidermal inclusion cyst, and urethral calculi was 2 cm x 2.5 cm x 1.5 cm, and 2 cm x 3 cm, respectively. Treatment were complete excision of cyst and removal of smegma stones by surgery and urethral calculi by dorsal urethrotomy. All patients had an uneventful postoperative period and were asymptomatic up to one year of follow-up.Conclusion: Results suggest that these complications can be managed with complete excision and surgical removal and care must be taken while performing the hypospadias repair to avoid these unusual late complications in patients.
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Background: Anemia is the most common nutritional deficiency disorder in the world. Maternal anemia has become one of the major health concerns worldwide. It is associated with adverse maternal and fetal outcomes such as increased rates of maternal and perinatal mortality, premature delivery, low birth weight and certain anomalies. This study was done to find out the correlation between maternal hemoglobin and birth weight and gestational age of newborn at birth.Methods: This is an observational clinical study, which' included 1501 pregnant mother and their newborn babies. All singleton live born babies born were examined. The pregnant women's lowest recorded hemoglobin measurement during pregnancy is correlated with outcomes of neonatal gestational age and birth weight.Results: Majority of the mothers belonged to lower middle class. 59.4% of the mothers were anemic. 21% of the babies born were preterm and 30% of the babies born were low birth weight.Conclusions: In India, according to WHO 2018 data, anemia in pregnancy is 65-75%. Present study outcome shows, preterm deliveries is 12.1% and low birth weight is 17.8% born to anaemic mothers who were 59.4%. The reduction in percentage of anaemic mothers in current study is due to National health programmes. In future, these programs will help to reduce the incidence of anaemia in pregnancy, which in turn will reduce low birth weight and preterm deliveries.
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Background: Neonatal encephalopathy, following severe birth asphyxia or perinatal hypoxia is referred to as hypoxic ischemic encephalopathy (HIE). Cerebral ischemia occurs as a consequence of cerebral oedema and reduced cerebral perfusion due to myocardial dysfunction as a result of hypoxic cardiomyopathy. Sarnat stage I -100% recovery, HIE stage II - 80% normal and 20% mortality and HIE stage III - 50% mortality and 50% morbidity. Relatively few studies have been made on outcome in HIE affected preterm infants. The aims and objectives of this study was to find out the neurodevelopmental outcome in preterm infants with HIE.Methods: This study is an observational clinical study, undertaken in Kempegowda Institute of Medical sciences and research centre, Bangalore, India. Study was performed between November 2016 to September 2018. 31 preterm infants with HIE were included in the study. Regular follow-up was done at 3, 6, 9, 12.15, 18 months by using Trivandrum development screening chart (TDSC) to stage II HIE infants.Results: The incidence of abnormal neurological outcome was 12.9%. Out of 31 preterm babies, stage I were 24, stage II was 4 (100% morbidity) and stage III were 3 (100% mortality).Conclusions: In present study, stage II HIE had 100% morbidity and moderate disability, stage III 100% mortality. Thus at 3-5 months of age during follow-up, when authors identify developmental delay, it is an ideal time to start interventional therapy to improve long term outcome.
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Background: Post graduate residents in tertiary care teaching hospitals in metropolitan cities bear the overwhelming burden due to heavy workload, they are at high risk of developing burnout syndrome, which in turn may affect hospital outcomes such as the quality and safety of the provided care.' This study was conducted to assess their perceived stress, stress induced somatic symptoms and coping strategies by postgraduates in Bangalore, India.Methods: This cross-sectional study was conducted on all postgraduates willing to participate in the study, pursuing their post-graduation in various specialties in Six medical colleges in Bangalore, India. Stress was assessed by Perceived stress scale (PSS-10), Stress induced physical symptoms using selected items from self-reporting questionnaire (SRQ-20), coping strategies using selected items from BRIEF COPE. Descriptive and inferential statistical analysis has been carried out in the present study.Results: The mean PSS score in present study was found to be 22.92 (moderate stress). Stress was associated with clinical specialty, higher workload, poor sleep quality due to more working hours, marital status, harmful ideations. In present study Post graduates of OBG, pediatrics, radiology demonstrated higher perceived stress score with a mean PSS Score of 25.57, 24.25, 24.22 respectively. Dermatology postgraduates reported lowest stress levels with a mean PSS score of 16.86.Conclusions: In present study post graduates are facing moderate stress, affecting their physical and mental health resulting in dysfunctional coping strategies and harmful ideations like quitting, which has an impact on quality and safety of provided care.
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Background: Coronary artery disease (CAD) is the major causes of death in the developed world. It has been reported that there is high prevalence of cardiac risk factors and associated morbidity in the adult population. These risk factors are known as the metabolic syndrome. Due to the alterations in lifestyle, low physical activity, the epidemic of obesity and insulin resistance, metabolic syndrome is a growing health problem in adults. Methods: In this study, 150 total numbers of cases were included. This study conducted in the Department of Medicine in K M Medical College & Hospital, Mathura. The duration of study was over period of one year. Results: In this study, 150 total numbers of cases were included. Out of 150 cases 65.4% were male and 34.6% were female.36% cases 51-60 age group predominantly found followed by >60 & <51. This study showed risk factor of Diabetic mellitus which were in 67 cases in IHD with metabolic syndrome group. While in IHD without metabolic syndrome group IHD higher risk found followed by other group. Conclusions: This study suggested that, Metabolic syndrome significantly increases the risk of coronary artery disease also. To prevent the development of metabolic syndrome, it is necessary to modify lifestyle.
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Background and Objectives: Stature estimation has a valuable importance for the anatomist, anthropologist and the forensic experts. Long bones are usually used for the estimation of individual height for the said purpose since 1952. The purpose of this study is to formulate a linear regression equation for the estimation of the stature of living female adult population from the length of ulna. Materials and Methods: This research was conducted at M.B. Kedia Dental College Birgunj on 150 subjects who were chosen from among the patients and their attendants in the OPD. The height was measured from the crown to the heel and the length of the ulna was measured from the tip of the olecranon process to the tip of the styloid process. The recorded data was calculated by the standard statistical software. Results: The correlation coefficient (r) was found to be 0.55(p<0.001) for the left ulna with stature and it was 0.463 (p<0.001) for the right ulna with stature after analyzing the data. Supportive regression equations and scatter-plot diagrams could successfully interpret the height from the ulnar length of the population. Conclusion: The ulna length can be used for estimating the height of an individual. The regression equation which were proposed in this study will be useful for forensic esperts, clinicians, anatomists, archeologists, and anthropologists . Such evidence provides the investigator to gauge that aspect of an individual’s physical description.
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Background and Objectives: Vallecular cysts are rare and generally asymptomatic. In infants and children they present with stridor, feeding difficulties, failure to thrive. Treatment is surgical excision with cautery or laser.Presentation of Case: We discuss the clinical, radiological presentation of a 7 months old child with vallecular cyst which was surgically treated with deroofing and marsupialisation with elecrocautery. There was no recurrence even up 2 years of follow-up.Discussion: Flexible nasopharyngolaryngoscopic examination was done which showed present of swelling in the left vallecula pushing the epiglottis posteriorly and to the right with narrowed normal endolarynx. Radiological investigations with CT scan showed cystic lesion noted in left side of neck with no septation and solid component. The lesion was extending to ipsilateral vallecula and paraglottic region with narrowing of endolarynx.Conclusion: Vallecular cyst is rare cause of noisy breathing in infants and children. In adults it is usually asymptomatic. Treatment of choice is marsupialization with electrocautery or laser.
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Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both processes are involved in the development of diabetes. Diabetes is also known as Madhumeha in Ayurveda. Diabetes Mellitus has become a global problem in spite of advances in modern science. Ancient science of Ayurveda has discussed diabetes at length thousands of years ago. Number of diabetic patients are increasing in very high range. Year by year, its growing speed is very fast. In Ayurveda there are many ways to prevent diabetes mellitus and to cure its complications. Ayurvedic medications and management is very helpful and very effective in specially for diabetes. In this paper, trying to explain the hypoglycemic effect of Momordica (Karela) in diabetes mellitus (Madhumeh). Karela is specifically used as a folk medicine for diabetes. Several researches proved that it contains a hypoglycaemic or insulin-like principle, designated as 'plant-insulin', which has been found highly beneficial in lowering the blood and urine sugar levels.
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Background: Recent evidence incidence that low level of lead exposure, previously thought to be safe, have adverse effects on neurobehavioural and cognitive development of the child. Aim: This study was a clinical study composed of children who were likely to be at higher risk for lead exposure. To correlate Blood lead levels with the clinical profile, developmental and behavioral profile and bio-chemical parameters of these children. Materials and methods: Patients attending Niloufer hospital, Hyderabad were evaluated for pica were considered to be at risk for inorganic lead poisoning and Children who working at petrol bunks were at risk of Organic Lead poisoning Results: Children of lower socio-economic state of classes of 3 and 4 and those living poor housing conditions are associated with high blood lead levels than children of higher and those in good housing conditions. Pica children had significantly higher blood levels, more behaviour problems and lower hemoglobin levels than controls. Pica particularly for multiple (mud, plaster, coal) and duration of habit for more than 6 months are associated with high blood lead levels. Children working in petrol bunks for more than 1 year showed a high Blood Pb levels and low hemoglobin levels than those working for less than 1 year and controls. Children of petrol bunk group, showed more behavioural problem and significant organic impairment and low intelligence than controls. Children of petrol bunk group, similar to pica group showed a high Blood Lead levels. Conclusion: Present study suggests that oral ingestion in an important route of inorganic poisoning in children with pica, where inhalation through respiratory passages and absorption through intact skin is an important route of organic lead poisoning in children working in petrol bunks or automobile garages-by virtue of their occupation.
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An accurate and precise UPLC method was developed for the simultaneous estimation of efavirenz and lamivudine in pharmaceutical dosage forms. The chromatographic analysis was performed on Acquity UPLC BEH Shield RP18 (50 × 3 mm, 1.7 μm) column with mobile phase consisting of 10% acetonitrile in methanol and 10 mM phosphate buffer (pH 4.0) in the gradient mode, at a flow rate of 0.4 mL/min, and eluents monitored at 254 nm. The calibration curves of peak area versus concentration, which was linear from 10-60 μg/mL for efavirenz and 5.0-30 μg/mL for lamivudine, had regression coefficient (r2) greater than 0.999. The method had the requisite accuracy, precision, and robustness for simultaneous determination of efavirenz and lamivudine in tablets. The proposed method is simple, economical, accurate, and precise and could be successfully employed in routine quality control for the simultaneous analysis of efavirenz and lamivudine in pharmaceutical formulations.
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Background: The variation of the radon progeny concentration in outdoor environment and meteorological parameters at fine resolution were studied for one year at a continental location, National Atmospheric Research Laboratory, Gadanki, India. Materials and Methods: The concentrations were measured using Alpha Progeny Meter by collecting air samples at a height of 1 m above the Earth's surface at a known flow rate. Results: Radon progeny concentration shows temporal variations on diurnal and monthly scales, and is due to mixing in the atmosphere. Peak in the early morning hours and low values during afternoon compared to nighttime are due to differential heat contrast between earth's surface and its atmosphere. However, the activity during February shows maximum compared to June/July months. The diurnal variation of radon progeny shows positive correlation with the relative humidity and negative correlation with ambient temperature. The monthly mean activity of radon progeny for the year 2012 was found to be 4.76 +/- 0.73 mWL. Conclusion: The mean concentration of radon progeny in the study region is relatively high compared to the other locations in India and may be due to the rocky terrains and trapping of air-masses near the observation site due to its topography