Cutting of sphincter in fistulectomy with primary closure in complex fistula-in-ano: is it feasible?

Introduction: Treatment of complex fistulas such as inter- or transsphincteric, recurrent, and high fistulae have high rate of recurrence or incontinence. Fistulectomy with primary sphincter reconstruction might represent an effective and safe alternative to reduce rate of recurrence and incontinence. The aim of this study is to assess incontinence and recurrence after fistulectomy with primary sphincter reconstruction for management of complex fistulas. Material and Methods: There were 60 patients with complex fistulae involving the sphincter, with 56 male and 4 female, mean age 40.6 years, operated by fistulectomy and primary sphincter repair over a period of 7 years. Patients were followed up for 6months for any complications, recurrence, and incontinence. Results: The majority of patients (50, 83.3%) had complete wound healing in 2 weeks, while 4 (6.6%) patients had hematoma and superficial wound dehiscence, which were managed conservatively and healed in 4 weeks. There was one recurrence. All patients had good continence postoperatively, except for mild fecal incontinence (FI, score 3), seen in 6 (10%) patients. However, all these patients regained continence within 6 weeks. Conclusions: Primary reconstruction of anal sphincter with fistulectomy is a safe option for complex fistula-in-ano. (AU)

They see, they learn: Pre-COVID-19 prevalence of refractive errors in school children in suburban areas of North India

Purpose: India has the largest population of youth in the world, thereby making them important contributors to the “India of Tomorrow”. Over 80% of knowledge gained is by the visual sense, thereby making school screening programs a necessity in our country. Data from the pre?COVID era, that is, 2017–18 was collected from close to 19,000 children in Gurugram, Haryana, a tier two city in National Capital Region, India. A similar prospective observational study is planned post COVID?19 (2022–23) for further analysis to depict the impact of COVID?19 in these areas. Methods: The program They See, They Learn was set at government schools in the area of operations (district of Gurgaon, Haryana), where the children and their families were unable to afford eye care services. All children who were screened underwent a comprehensive eye examination at the school premises itself. Results: A total of 18,939 students were screened over a period of 18 months, covering a total of 39 schools in the Gurugram belt, in the first phase of the program. Eleven point eight percent (n = 2254) of all school students had some form of refractive error. Girl students were found to have a higher refractive error rate (13.3%) compared to boy students (10.1%) across the schools screened. Myopia was the most common type of refractive error. Conclusion: School students require perfect vision or else they can be discouraged and may become a major burden to the economy of any developing nation. A school screening program aiming at populations that cannot afford such basic needs like spectacles is a must in all zones of the country

Awareness and knowledge among paramedical staff about glaucoma surgeries and post-surgery counseling – A questionnaire based study at a tertiary eye care center in Central Rural India

Purpose: To determine the level of awareness and knowledge about glaucoma surgery and post?surgery counseling amongst paramedical staff at a tertiary eye?care hospital. Methods: This observational cross?sectional study included a random sample of 94 hospital personnel: 37 general nurse midwives, 47 ophthalmic assistants, and 10 patient caretakers (PCTs). Participants were administered a questionnaire about glaucoma surgery and post?surgery counseling of patients. Results: The study included 41 (43.6%) females and 53 (56.4%) males. The mean age of the participants was 24.85 ± 4.54 years. All participants were aware of trabeculectomy surgery in glaucoma (100%). A total of 95.7% knew that surgery helps in controlling IOP, of whom 57 (60.6%) participants got information during their course of learning. Overall 53 (56.4%) believed that surgery is done when medication failure occurs, and 58 (61.7%) knew that surgery helps in preserving vision. A total of 63 (67.0%) participants knew to counsel patients to visit an ophthalmologist when called for and take the treatment as advised, whereas 74 (78.7%) correctly said to visit an ophthalmologist immediately if pain/diminution of vision/discharge occurs. Overall, PCTs were found to be having significantly better knowledge (P = 0.01) compared to others and they also reported ophthalmologists as the chief source of information. Conclusion: This study revealed that paramedical staff had an excellent awareness of trabeculectomy surgery. However, the knowledge and counseling parts of the questionnaire revealed less than satisfactory responses. So, there is a need to continuously educate paramedical staff members so that they can help in propagating information about the role of glaucoma surgery and the importance of proper follow?up

In silico screening of plant peptides against the envelope protein of dengue virus

@#Peptide therapeutics are found to be an emerging and attractive class of treatment due to their highly specific and safe nature. Hence twenty plant peptides were subjected to screening by molecular docking against the envelope protein of the dengue virus using Clus Pro, Patch Dock, and HADDOCK servers. Physicochemical parameters, allergenicity, and toxicity profile of the plant peptides were estimated by Protparam analysis, AllergenFP, and ToxinPred web servers. Six potential compounds namely Ginkbilobin, Cycloviolin-D, Circulin-B, Circulin-A, Cycloviolacin-013, and Circulin-C showed the highest binding energy with both nonallergenic and nontoxic properties. They also exhibited desirable half-lives extending to 30 hrs except for Ginkbilobin, which showed the least half-life of 4.4 hours and non-polar activity. The residues of Ala-4 of Ginkbilobin; Arg-30 of Cycloviolin D; Arg-29 of Circulin A and C interacted with the Try 101 of the domain II of Envelope protein, implying the possible inhibition of the insertion process of the trimeric E protein during fusion with the host cells. Thus, the identified plant peptides could serve as potential leads upon further subjection to in vitro studies.

Trametes versicolor (L.) Lloyd as a source of thermostable serine protease: production and characterization

Proteases are ubiquitously present and are among the largest groups of commercially important enzymes. Here, we investigated a wood-rot basidiomycete Trametes versicolor (L.) Lloyd [Syn. Coriolus versicolor (L.) Quél.; Polyporus versicolor (L.) Fr.] as a source of the enzyme serine protease, its production, and optimized to obtain a higher yield of the enzyme.. The significant variables with optimized values for maximum production of the enzyme were temperature (30?C), incubation time (120 h) and wheat bran (10 g). The yield increased by 30.76% by statistically optimizing the media. The optimized temperature and pH for the maximum protease activity was 50?C and pH 7.0, respectively. The enzyme was purified through ion exchange (using DEAE cellulose 52 resin) and gel filtration chromatography (using Superdex 200 column). The purified enzyme had a retention time of 7 min in RP-HPLC. The enzyme was stable at a broad range of temperature (30-60?C) and pH (5.0-8.0) with a half-life of 58.72 min, Vmax of 37.17 ?M min/mL and Km of 0.657 mg/mL. Its activity was enhanced by Na+, Ca2+, Mg2+ ions and SDS surfactant. These properties make this enzyme a valuable candidate for industrial applications

Predictors of toxicity after neoadjuvant chemoradiotherapy for locally advanced gall bladder cancer

Background: The present study evaluated the correlation of hepatobiliary toxicity and radiation dose received in patients undergoing neoadjuvant chemoradiotherapy (NACRT) for locally advanced unresectable gall bladder cancers (LAGBC). Methods: Twenty-six patients with LAGBC, treated with NACRT (55–57 Gy/25 fractions/5 weeks and weekly gemcitabine 300 mg/m2) within a phase II study, were included. Whenever feasible, surgery was performed after NACRT. Acute and late hepatobiliary toxicity was recorded. Treatment scans were retrieved to delineate central porto-hepatobiliary system (CPHBS), resected liver surface, segment IV B and V, and duodenum. The doses received by these structures were recorded and correlated with toxicity. Results: Of 26 patients, 20 (77%) had partial or complete response and 12 (46%) had R0 resection. At the median follow-up of 38 months, overall survival was 38%. Eight (30%) patients had post-treatment toxicity, of which most common was biliary toxicity (30%). A correlation was observed between the biliary leak and V45Gy CPHBS >50 cm3 (P = 0.070). Higher toxicity was observed in those with metallic stents (P = 0.072). Conclusion: The incidence of the biliary leak was 46%. CPHBS dose was found to correlate with biliary leaks. Restricting V45Gy CPHBS <50 cm3 and using plastic stent may facilitate a reduction in hepatobiliary toxicity in patients undergoing NACRT and surgery.

Knowledge regarding breast self examination among adolescent girls

Introduction: A breast exam is a self-inspection of the breasts. During a breast exam, eyes used to see and hands to observe the appearance and feel the breast. Breast exams allow becoming more familiar with girls breasts. Materials and Methods: This study made use of an evaluative approach with one group pretest and post test design. The sample for the study sample comprised of 60 adolescent girls. A disproportionate purposive sampling technique was used to select 60 adolescent girls. The tool and STP were validated by 7 experts. Pre testing and reliability of the tool was established prior to pilot study. Pilot study was conducted among ten adolescent girls. this gave basis for the invigilator to conduct the actual study .the actual study was conducted among 60 adolescent girls .following the pretest, STP Was administered and post test was conducted seven days after the administration of STP. The obtained data was analyzed in terms of the objectives and hypothesis using descriptive and inferential statistics. Interpretation: The finding of the study showed that STP is an effective teaching strategy to increase knowledge of adolescent girls. Results: The finding of the study proved that adolescent girls lacked knowledge about breast self examination. The STP given by the investigator helped the adolescent girls to improve their knowledge and the finding showed that it is statistically significant at 0.05 level of significance.

Bilateral Facial Nerve Palsy after Sars-Cov2 Infection in Pediatric Patient

COVID-19 infection has been associated with several neurologic manifestations including anosmia, acute ischemic stroke, Guillain-Barré syndrome, encephalopathy and cranial nerve involvement. Though multiple cases of unilateral facial nerve palsy have been reported but bilateral facial palsy is very rare. Our case was 12 years old female patient who presented with difficulty in closing mouth, drooling of saliva and change in voice. On examination, there was loss of bilateral nasolabial folds, nasal twang of speech and incomplete eye closure bilaterally. Laboratory reports suggested raised CRP and amylase along with positive Immunoglobulin IgG covid-19 antibodies. Magnetic Resonance Imaging of brain and neck showed no abnormality. The child was managed conservatively with supportive care, subsequent to which she gradually improved over next 4-6 weeks. To the best of our knowledge, this is the first pediatric case where SARS-COV2 infection was found to be associated with bilateral facial nerve palsy as a post covid complication. Therefore, bilateral facial palsy should be considered as one of the associations of COVID especially in the present era. A detailed history and examination should be done as it often gets missed due to bilateral involvement. All differential diagnosis should be ruled out by relevant laboratory & radiological tests. Most children are likely to recover well with supportive treatment.

A study of lipid profile in young smokers and non-smokers

Background: A prospective study was carried out to find the variations in lipid profile in smokers when compared to non-smokers. The aim was to study the alterations in lipid profile in terms of severity of smoking.Methods: This study was carried out among 198 patients who attended medicine OPD of LLR hospital GSVM medical college Kanpur. The population was divided into 98 non-smokers and 100 smokers. The smokers were furtherdivided into 3 groups depending on the intensity of smoking. Results: Out of 100 patients inthe present study the number of subjects in mild, moderate and high smokers’ group were 33 (33%), 33 (33%), 34(34%) respectively. Smokershad higher total cholesterol, plasma triglycerides, serum low density lipoprotein (LDL), serum very low-densitylipoprotein (VLDL) and lower levels of serum high density lipoprotein (HDL) compared to non-smokers which wasstatistically significant. Conclusions: Increase in total cholesterol, triglycerides, LDL and VLDL were found in smokers of all age groups. Whereas HDL values showed inverse relationship. These changes were directly proportional to the severity of smoking. So, Tobacco smoking is associated with dyslipidemiawhich is atherogenic in nature.

Role of nanomaterials in catalytic reduction of organic pollutants

Developing innovative technologies for the effective treatment of wastewater containing organic pollutants is of extreme importance across the globe. The organic pollutants such as dyes and nitrophenols are the common hazardous pollutants known for their adverse effects on humans and aquatic organisms. Various methods have been used for the removal of organic pollutants from wastewater but they suffer limitations such as high cost, time consuming removal process and production of sludge or toxic by-products. In recent years, chemical reduction method is becoming popular for removal of organic pollutants using various nanomaterials as catalysts. Nanomaterials show great potential for removal of organic pollutants due to large surface area which provides high catalytic activity. In the present review, current studies on catalytic reduction of organic pollutants (dyes and nitrophenols) using four different types of nanomaterials specifically carbon nanotubes, silica, metal oxide and chitosan polymer based have been explored. The factors affecting the catalytic process and mechanism of catalysis is explained in detail.In addition, a critical discussion about the pros and cons of each nano-catalyst have also been included for developing better understanding of the choice of catalyst.

Green electrochemical sensors based on ionic liquid nanocomposites for detection of environmental pollutants

Industrialization and globalization have caused a huge burden on the limited natural resources, which releases various environmental pollutants such as toxic metal ions and pesticides. World Health Organisation (WHO) has set a maximum permissible limit for these toxic pollutants in water, above which, it is unsuitable for drinking purpose. There are various techniques available for the determination of such pollutants like ICP-MS, HPLC, FAAS etc. that are costly, cumbersome, and time consuming. Whereas, electrochemical sensors are portable, fast and can perform multi-analyte sensing. Electrochemical sensor can be made selective by fabricating with nanocomposites having different functional groups. Nowadays, trend of utilizing greener materials in research field is being highly appreciated in accordance with the principles of green chemistry for the application and development of electrochemical sensors. Ionic liquids having non-volatility, low toxicity, wide potential window, high electrochemical stability and conductivity have shown sustainable electrochemical sensing applications. Nanocomposite of these ionic liquids as a sensing platform have been extensively used in electrochemical detection of various pollutants. This work provides a literature survey of different ionic liquid nanocomposite based sensing platform for electrochemical detection of toxic pesticides and heavy metals. They have demonstrated good sensitivity with detection limit below WHO guidelines.

Prevalence of dental fluorosis and dental caries in fluoride endemic areas of Rohtak district, Haryana

Objectives: This study investigates the estimation of the fluoride concentration in drinking water in Rohtak district, Haryana, and quantifies its effect on the prevalence of dental fluorosis and dental caries. Materials and Methods: A cross-sectional survey was conducted among 1262 school children in endemic fluoride areas of Haryana. Using simple random sampling, thirty villages from five blocks of Rohtak districts were selected, and children 6–12 years of age were examined. A questionnaire survey form was filled out to record the demographic details of the samples. Dental caries was recorded according to DMFT (D = Decayed, M = Missing due to caries only, F = Filled, T = Teeth)/deft index (d = decayed, e = extracted due to caries, f = filled, t = teeth). Assessment of Dental Fluorosis was done according to Dean's Fluorosis index, modified in 1942. The data were analyzed using SPSS version 19, and nonparametric tests were used to assess the significance. Results: The study participants included 615 males and 647 females among which Mean DMFT in the area of study ranged from 0.32 to 1.90. Mean deft in the area of study ranged from 0.34 to 1.91. The fluoride concentrations in groundwater are in the range of 0.532–8.802. Out of 1262 children examined, 655 (51.90%) children were having dental fluorosis. 607 (48.10%) of the subjects were free from fluorosis. 16.09%, 13.39%, 9.11%, and 8.16% and 5.15% were having questionable, very mild, mild, moderate, and severe form of fluorosis, respectively. Conclusion: It can be concluded that in Rohtak district, the fluoride levels in drinking water and the prevalence of dental fluorosis are high, so requiring an urgent need to improve the quality of water and institute de-fluoridation of drinking water in affected areas to lower the burden of dental fluorosis in the community.

Analysis of docosanol using GC/MS:Method development,validation,and application to ex vivo human skin permeation studies / 药物分析学报

Docosanol is the only US Food and Drug Administration(FDA)approved over-the-counter topical product for treating recurrent oral-facial herpes simplex labialis.Validated analytical methods for docosanol are required to demonstrate the bioequivalence of docosanol topical products.A gas chromatography/selected ion monitoring mode mass spectrometry(GC/SIM-MS)method was developed and validated for docosanol determination in biological samples.Docosanol and isopropyl palmitate(internal standard)were separated on a high-polarity GC capillary column with(88％cyanopropy)aryl-polysiloxane employed as the stationary phase.The ions of m/z 83 and 256 were selected to monitor docosanol and isopropyl palmitate,respectively;the total run time was 20 min.The GC/SIM-MS method was validated in accordance with US FDA guidelines,and the results met the US FDA acceptance criteria.The docosanol calibration standards were linear in the 100-10000 ng/mL concentration range(R2＞0.994).The recoveries for docosanol from the receptor fluid and skin homogenates were＞93.2％and＞95.8％,respectively.The validated method was successfully applied to analyze ex vivo human cadaver skin permeation samples.On applying Abreva?cream tube and Abreva?cream pump,the amount of doco-sanol that penetrated human cadaver skin at 48 h was 21.5±7.01 and 24.0±6.95 ng/mg,respectively.Accordingly,we concluded that the validated GC/SIM-MS was sensitive,specific,and suitable for quantifying docosanol as a quality control tool.This method can be used for routine analysis as a cost-effective alternative to other techniques.

Vitamin D-dependent rickets (VDDR) type 1: case series of two siblings with a CYP27B1 mutation and review of the literature / Raquitismo dependente de vitamina D: tipo 1: série de casos de dois irmãos com mutação CYP27B1 e revisão da literatura

Abstract Two siblings presented with clinical and biochemical features of rickets, initially suspected as hypophosphatemic rickets. There was no improvement initially, hence the siblings were reinvestigated and later diagnosed as having vitamin D-dependent rickets (VDDR) type 1 due to a rare mutation in the CYP27B1 gene encoding the 1α-hydroxylase enzyme. Both siblings improved with calcitriol supplementation. The initial presentation of VDDR is often confusing and algorithmic evaluation helps in diagnosis. We also present a brief review of the literature, including genetics.

Resumo Dois irmãos apresentaram características clínicas e bioquímicas do raquitismo, com suspeita clínica inicial de raquitismo hipofosfatêmico. Não houve melhora no início, portanto os irmãos foram reavaliados e, posteriormente, diagnosticados com raquitismo dependente de vitamina D (VDDR) tipo 1 devido a uma rara mutação no gene CYP27B1, que codifica a enzima 1a-hidroxilase. Ambos os irmãos melhoraram com a suplementação de calcitriol. A apresentação inicial do VDDR geralmente é confusa e a avaliação algorítmica ajuda no diagnóstico. Também apresentamos uma breve revisão da literatura, incluindo genética.

Female sterilization failure, consequences and further contraception: a review of cases over ten years

Objective: To study the socio-demographic profile and etiological factors responsible for failure of tubal ligation. Their outcome and further adopted methods of contraception.Methods: This was a retrospective observational study done in a tertiary care centre from January 2009 to December 2018. All cases who came with sterilization failure were reviewed including their demographic patterns, previous methods used and the contraception choices adopted after procedural failure.Results: Over a period of ten years, out of a total of 157 cases of sterilization failure 43.33% (n=68) were laparoscopic interval ligation, 42.60% (n=67) were laparoscopic ligation with termination of pregnancy, 10.20% (n=16) were sterilization done along with lower segment cesarean section and 1.9% (n=3) were mini-laparotomy (minilap) done in postpartum period. Only 63.05% (n=99) got repeat sterilization procedure done despite previous failure. Out of 157 cases, in 50.9% (n=80) recanalization was found, tuboperitoneal fistula was responsible in 5.7% (n=9) women, slipped fallope ring was found in 5.7% (n=9) women, wrong application of fallope ring was seen in 1.9% (n=3) and 35.6% (n=56) did not opted for religation.Conclusion: Failures of sterilization procedures do exist especially in laparoscopic ligation. Counseling prior to adoption of this method, risk of failure and other noninvasive options of contraception must be discussed.

A Comparative Study of Problems Faced by the Young- Middle Aged- / Elderly-Adults during COVID Pandemic in Delhi-NCR (National Capital Region)

As the pandemic of COVID-19 has hit the globe, the associated uncertainty is progressively testing the psychological resilience of the masses in India too. Accordingly, the global focus has been mostly on scrutinizing, finding a cure and preventing its transmission; people are facing innumerable psychological problems, adjusting to the current lifestyles and also living in fear of the infection from disease. Since there is a severe dearth of research on this issue, it was decided to conduct an online survey to compare the problems faced by young and middle-aged / elderly adults in the society in Delhi-National Capital Region (NCR) during the lockdown period due to COVID-19. We wanted to analyse and compare the problems faced by young and the middle aged / elderly adults in Delhi NCR during the lockdown period of COVID-19 pandemic. METHODSA total of 450 people had given their consent to participate in this survey through a cross sectional survey during the lockdown period in Delhi-NCR region. Two separate questionnaires were created through google forms and were distributed via WhatsApp groups and other social media platforms. It consisted of 25 questions each based on the problems faced by the young and the middle aged / elderly adults. RESULTSThe study revealed that the young aged and middle-aged / elderly adults were similarly affected due to the lockdown. It also showed that the young adults were concerned to some extent about the studies in the school, college and university through online classes, not able to mix up with their friends for happy hours, getting bored and spending time watching movies / web series, and faced some mood swings due to the restrictions of COVID-19; whereas, the middle-aged / elderly adults were under a fear of getting infected, isolation, work from home, not able to help their relatives, confusion due to change in their routine, losing jobs, and were also upset with the reduction of their salary. CONCLUSIONSBoth the groups were similarly frustrated and stressed but for different reasons during this lockdown and in order to cope with the psychological stress, they should be counselled and given stress relieving sessions or should indulge in updating knowledge, skills etc. by attending to various online webinars, workshops etc.

Synchronous endometrial and ovarian cancer: a rare presentation

Synchronous primary cancers are relatively uncommon in the general population. About 0.5 -1.7% of gynecological malignancies have synchronous primary cancer of female genital tract. Amongst the synchronous gynecological malignancies synchronous endometrioid carcinoma is most common and has good prognosis. Patients with synchronous endometrioid tumors of endometrium and ovary are usually younger, have low grade number, and their prognosis is better than other histologic types. The authors are presenting a case of 38 years old nulliparous obese woman with pain in abdomen and heavy menstrual bleeding for a duration of four months. The MRI pelvis was suggestive of well defined, lobulated, complex, solid cystic multiseptated lesion measuring 8.8×7.7×8.8 cm in right adnexa, with anteverted uterus, and a bulky indistinct emdomyometrial junction. Histopathology revealed synchronous endometrial carcinoma of both uterus and ovary.