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Ileal neuroendocrine tumors are rare primary epithelial neoplasm arising from enterochromaffin cells. A 65-year-old male presented with complaints of recurrent abdominal pain of 1 year duration. The pain was more aggravated in last 7 days associated with vomiting, loss of appetite and diarrhea. On radioimaging ultrasonography finding impression of small bowel mass lesion suggestive of ileac carcinoid tumor with ischemic bowel disease was given. Computerized tomograph abdomen pelvis showed a welldefined hypodense, round, hetergenous, enhancing mass measuring 2.6x1.6x1.2 cm., showing arterial enhancement in mesentery in close relation to ileum and metastatic lymph node mass- indicating likeness of neuroendocrine tumor. The surgical resection of ileum with mass and enlarged mesenteric nodes were done. On gross examination ileum specimen on cut open showed multiple, irregular mucosal thickenings with foci of ulceration. The submocosa showed single, circumscribed, round tumor measuring 3 x 2.5x1.5 cm. Cut section of tumor was yellowish, tan, well circumscribed and solid. The mesenteric lymph nodes were enlarged. The microscopic examination ileum showed a tumor composed of uniform, round cells having to oval nuclei with salt and pepper chromatin. Tumor cells were arranged in trabecular, nests, ribbons and in areas pseudo glandular pattern. Increased mitotic activity was noted (4/10 high power field). Mesenteric lymph nodes were involved by tumor. On histopathology reported as Well-differentiated neuroendocrine tumors (NET), G2, intermediate grade of ileum. The immunohistochemical stain were positive for synaptophysin, chromogranin A. The Ki-67 expression was <1%. Herewith we are presenting rare case of well-differentiated neuroendocrine tumor NET, G2, intermediate grade of ileum for its clinical, radio imaging ,pathological features and management.
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Introduction: Thyroid lesions are fairly common and have a wide spectrum of diseases ranging from functional, immune mediated to neoplastic lesions. Malignancy of thyroid constitutes approximately 1% of all cancers. These malignant tumors of thyroid gland exhibit a variety of histopathologies and clinical behavior. Immune markers are gaining more and more importance in diagnostic pathology, especially in the differential diagnostics and in the grading of thyroid gland tumors. In the recent times Galectin-3 has received notable recognition for its usefulness as a diagnostic marker for thyroid cancer. To evaluate the diagnostic role of galectin-3 (Gal-3) in Aims and objectives: differentiating malignant from benign thyroid neoplasm. In this observational study, we evaluated Gal-Material and method: 3 expression in a spectrum of all non-neoplastic and neoplastic lesions including benign and malignant lesions of thyroid gland. All types of thyroidectomy specimens were xed in 10% formal saline and subjected to histopathological examination. Sections were stained with H&E stain. Gal-3 immunoperoxidase reaction was carried out in histological sections from all the cases and descriptive analysis was done. In the study of 100 cases of thyroid swelling were included and evaluated by Result: histopathological and by using Gal-3 immunoperoxidase marker. Out of 100 cases, majority of thyroid lesions were seen in females with 76 cases (76%) while only 24 cases (24%) were seen in male. Among 66 non-neoplastic cases, only 6 cases (9.1%) and among 34 neoplastic lesions, 28 cases (82.4%) were positive for galectin-3 marker. Statistical signicance of galectin-3 expression between non-neoplastic and neoplastic thyroid lesions found to be statistically signicant (P value <0000.1). The sensitivity and specicity of galectin-3 detection of malignant lesions were found to be 82.4% and 91% respectively with 82.4% positive predictive value and 90.9% negative predictive value. We suggest that Galectin-3 expression is helpful in Conclusion: enabling better diagnosis and patient care by guiding appropriate therapeutic decisions.
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Context: In India nearly 71% of adolescent girls have no knowledge about menstruation until menarche. Menstrual practices still face several social, cultural, and religious restrictions and discouragement of open discussion on the topic acts like a major deterrent in the path of menstrual hygiene management. Moreover, lack of knowledge and incorrect practices during menstruation can sometimes have serious health outcomes. Hence, it becomes imperative to ascertain the knowledge of adolescent girls about menstruation and reproductive health and the practices adopted by them during menstruation so that health education programs can to tailored to address the gaps. The study Aims: aims to assess the knowledge of adolescent girls and their current practices with regard to menstrual hygiene and reproductive health and study the association of these with socio-demographic variables. This cross-sectional community based Methods: descriptive study was conducted among 181 adolescent girls selected from two urbanized villages of Meerut district of India using a semi-structured questionnaire. For assessment of level of knowledge a scoring system was developed. Both descriptive and inferential statistics were used for analysis. Based on the scoring, 77.3% of our study participants had overall poor Results: knowledge about menstruation and reproductive health, nearly 20% had satisfactory knowledge and only 2.2% had good knowledge. Most participants reported using sanitary napkins during menses (80.7%) and the remaining were using clean cloth (19.3%). 100% of the participants whose mothers were illiterate had poor knowledge about menstrual hygiene and reproductive health. Participants whose mothers were engaged in semi-skilled or skilled work were more likely to have satisfactory (39.4%) or good (4.3%) knowledge scores. Overall knowledge of our study participants regarding Conclusion: menstrual hygiene and reproductive health was poor; however the practices adopted by them during menstruation were good. The two main impediments in the path of menstrual hygiene management were lack of knowledge and non availability of services at affordable cost
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Objectives : To study the biometric measurements of the submandibular salivary gland in the Indian population using Computed Tomography. Materials and Methods : From the available database, 300 patients who have undergone Computed Tomography without any salivary gland disease, the CT scans were retrospectively evaluated. The CT scans were obtained with TOSHIBA Activion 16 slice CT machine. The antero-posterior, transverse and cranio-caudal dimensions of bilateral submandibular salivary glands were measured in the axial, coronal and sagittal planes. Results : The mean CT measurements of the patients included was 2.0 ± 0.38 cm in Antero-posterior, 2.1 ± 0.31 cm in Transverse and 2.90 ± 0.27 cm in Cranio-caudal dimensions. The average volume of the submandibular gland was 6.68 ± 0.21 cc.
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Background: Psoriasis is associated with significant morbidity and impaired quality of life. Identification of the host genes that influence disease susceptibility and can potentially guide future, targeted therapy is the need of the hour. Aims: The aim of the study was to investigate the associations of macrophage migration inhibitory factor (MIF) gene polymorphisms, that is, a 5–8-CATT tetra nucleotide repeats at -794 (-794*CATT5–8) and a single-nucleotide polymorphism at -173 (-173*G/C) with the risk of chronic plaque psoriasis and to observe the correlation, if any, of disease determinants with genetic functional variants and circulating MIF levels. Methods: Five hundred and seventeen individuals (265 psoriasis patients and 252 controls) were genotyped for MIF gene polymorphisms. Data were analyzed with respect to disease susceptibility, serum MIF levels, disease severity, age at onset, disease duration and presence of comorbidities. Results: The presence of co-morbidities was more frequently noted in patients with late onset disease (P = 0.01). No statistically significant differences were observed either in genotype (P = 0.680) or allele frequency (P = 0.69) with respect to distribution of MIF-173*G/C polymorphism between patients and controls. The frequencies of genotypes -794*CATT 5/7 and 7/7 were significantly lower in patients (P = 0.027* and 0.038*, respectively). CATT*5/MIF-173*C haplotype occurred at a higher frequency in patients (odds ratio 3.03, 95% confidence intervals 1.09–8.47, P = 0.02). The mean serum MIF levels were significantly higher in patients as compared to controls (P < 0.001). The presence of either extended MIF -794*CATT repeats or C allele did not reveal any significant association with serum MIF levels or age at onset. Analysis of effect of various disease determinants revealed no significant association with genetic variants and serum MIF levels. Limitations: The lesional expression of MIF could not be studied. Conclusion: Our results showed that CATT*5/MIF-173*C haplotype is associated with increased susceptibility to psoriasis vulgaris.
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Background@#Lateral elbow tendinopathy (LET) has an array of modalities described for its management. The present study analyzed two modalities used for managing the condition. @*Methods@#The present study included 64 non-athletes with LET who failed conservative treatment that included avoiding strenuous activities, ice-fomentation, non-steroidal anti-inflammatory drugs, bracing, and physiotherapy for 6 months. A random allocation of the participants was done, with one group injected with platelet-rich plasma (PRP) and the other group with corticosteroids.The procedure was performed by the same blinded orthopedic surgeon after localizing the pathology using ultrasound. Visual analog scale (VAS) scores, disabilities of the arm, shoulder and hand (DASH) scores, Patient-Rated Tennis Elbow Evaluation (PRTEE) scores, and handgrip strengths were recorded by blinded observers other than the surgeon administering the injection. @*Results@#The average age of the patients was 40 years. The mean VAS score at the latest follow-up of 2 years in the PRP group was 1.25 and it was significantly better than the score of 3.68 in the steroid group (p < 0.001). The mean DASH score at the latest follow-up of 2 years in the PRP group was 4.00 and it was significantly better than the score of 7.43 in the steroid group (p < 0.001).The mean PRTEE score at the latest follow-up of 2 years in the PRP group was 3.96 and it was significantly better than the score of 7.53 in the steroid group (p < 0.001). The scores were better in the steroid group at a short-term follow-up of 3 months (p < 0.05), while they were better in the PRP group at a long-term follow-up of 2 years (p < 0.05). Hand-grip strength was comparable in the PRP group (84.43 kg force) and steroid group (76.71 kg force) at the end of the 2-year follow-up with no statistically significant difference (p = 0.149). @*Conclusions@#Corticosteroid injections alleviated symptoms of LET over short-term follow-up providing quicker symptomatic relief; however, the effect faded off over the long term. PRP injections provided a more gradual but sustained improvement over the longterm follow-up, indicating the biological healing potential of PRP.
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Click chemistry has been proven to be very useful in drug delivery. Due to the availability of a large number of click reactions with a various characteristics, selection of appropriate chemistry for a given application is often not a trivial task. This review is written for pharmaceutical researchers who are interested in click chemistry applications and yet may not be click chemistry experts. For this, the review gives an overview of available click reactions organized by application types. Further, the general understanding of click reactions being fast and high yielding sometimes overshadows the need to analyze reaction kinetics in assessing suitability of a given reaction for certain applications. For this, we highlight the need to analyze the relationship among reaction kinetics, concentration effects, and reaction time scales, knowing that lack of such analysis could easily lead to failures. Further, possible issues such as chemical stability with various click reagents are also discussed to aid experimental designs. Recent examples and extensive references are also provided to aid in-depth understanding of technical details. We hope this review will help those interested in using click chemistry in drug delivery to select the appropriate reactions/reagents and minimize the number of pitfalls.
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Environmental pollution is serious threat for all living organisms. Nanoparticle synthesis using green approach is a non-toxic, easy and energy saving process. Varieties of species have the unique capability to synthesize commercially useful nanoparticles from various metal salt precursors that can help in environmental remediation. The combination of nanotechnology and bioremediation is known as Nanobioremediation. Researchers have shown that biologically nanoparticles shows great potential in reducing environmental pollution from water and soil by adsorption of pollutants and harmful toxic substances from their environment .These green nanoparticles can convert toxic chemicals into less toxic form. Studies also shown that metal nanoparticles also help in removal of harmful bacteria and fungi from environment which can cause diseases in living system. Green synthesised nanoparticles shows very promising results when it comes to environmental remediation they have been used as dye degrader,Oil degrader, photocatalytic agents, biosensors, heavy metals and persidtent organic particulate (POPs) absorbers etc. This review focus on the current status of different types of biologically synthesised nanoparticles in environmental pollution from different species and future challenges associated with environmental remediation.
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The formation of fistulous tract between the kidney and adjacent organs is not uncommon while cutaneous fistulization is a rarer occurrence. We present a case of Nephrocutaneous Fistula without prior history of surgery or interventional procedure. Our case involves long standing obstructive pyonephrosis secondary to obstructing calculus at the ureteropelvic junction which led to formation of a fistulous tract upto the skin surface. This patient had complaints of purulent discharge from the right flank region associated with fever spikes since the last 1 month. The cutaneous manifestation in specific location should raise the possibility of underlying renal pathology
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Background: Microalbuminuria is multifactorial and it is an important marker for diabetic nephropathy. The aim of thestudy was to assess the incidenceand association of serum magnesium levels, serum uric acid levels and microalbuminuria in patients with type 2DM. Methods:This study was a cross-sectional study conducted for a period of 2 years from October 2015 to September 2017, where the patients diagnosed as type 2 DM admitted in AJIMS were taken up for the study. All the patients’ blood sample was sent for estimation of serum magnesium, serum uric acid, FBS, PPBS, HBA1C and urine spot albumin:creatinine ratio. Results:In our study, out of 100 patients with type 2 diabetes, 79 patients had microalbuminuria. Out of these, 83.3% (N=75) was having hypomagnesemia (p<0.000) associated with microalbuminuria. Hyperuricemia was seen in 63% (N=63) of the population but 79.4% (N=50) hyperuricemics were associated with microalbuminuria(p<0.000).Conclusions:There was a significant microalbuminuria in patients with type 2 DM, with reduced serum Mg levels and elevated serum uric acid levels ascompared with patients who had serum Mg and uric acid levels withinthe normalrange.
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Background: The distal radial artery (dRA) approach at anatomical snuff box has gained attention of the interventional cardiologist in last few years. The procedural success rate by this novel approach depends on size of the radial artery and therefore the study was planned to study the size of distal radial artery. Methods: Total of 1004 patients of >18 years of age undergoing coronary catheterization were included in the study. The vessel diameter was measured from media to media in the anatomical snuff box a day prior to coronary catheterization. Results: The mean diameter of right radial artery at conventional access site was 2.56 ± 0.35 mm and at distal access site 2.23 ± 0.39 mm (p < 0.001). Females had significantly smaller radial artery diameter as compared to males at right conventional access site (2.42 ± 0.36 mm vs 2.60 ± 0.34 mm; p < 0.001) and distal access site (2.09 ± 0.38 mm vs 2.27 ± 0.39 mm; p < 0.001). The diameter of the right dRA was not significantly correlated with age (r2 linear ¼ 0.002, p ¼ 0.0475) but was positively correlated with height and weight (r2 linear ¼ 0.076, p ¼ <0.001 and r2 linear ¼ 0.005, p ¼ <0.001) and negatively correlated with BMI (r2 linear ¼ 0.076, p ¼ 0.519). Conclusions: This study has shown the size of right dRA 2.27 þ 0.39 mm in males and 2.09 þ 0.38 mm in females. Diabetes, hypertension, height and weight are important predictors of dRA diameter
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Background: COVID-19 presented a unique scenario among children, specifically all over the world. The children had decrease outdoors activities and learning times, increased use of electronic gadgets and changes in sleep patterns. These altered behavior patterns of children directly influenced their behavior in the dental operatory. This coupled with the stringent protocols of COVID-19, made the behavior management of children a tedious task. However, as they say that necessity is the mother of all inventions, the pediatric dentist took this time to evaluate newer methods of behavior management and modified old strategies with newer modifications. Aim: The main aim of this study was to observe the modifications in behavior management strategies among pediatric dentists in the post-COVID-19 era while managing the child in dental operatory. Materials and Methods: Four hundred pediatric dentists were mailed a questionnaire consisting of 24 open and closed-ended questions consisting of personal data, professional information, and questions regarding various behavior management techniques used by them in pre- and post-COVID-19 era. Data obtained were subjected to statistical analysis using SPSS version 26.0, IBM, and a comparison of frequencies of categories of variables with groups was made using Chi-Square test and McNemar test. Results: The results showed that there were statistically highly significant changes in behavior management strategies pre- and post-COVID-19 scenario with P < 0.01. Conclusion: Conventional techniques like Tell-Show-Do were popular in both pre- and post-COVID-19 times with minor modifications in approach, but conscious sedation and distraction techniques were evaluated to have gained more popularity in the post-COVID-19 times along with exploration of new novel techniques.
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Introduction: Poisoning is a significant public health problem in developing countries, more so in rural areas. Very little is known about the treatment available for poisoning cases in the context of rural health care provision in India. This study explores the perceptions of the primary health care medical officers regarding the management of poisoning cases. Material and Methods: A semistructured, self-designed survey form was used to interview the medical officers in Pune district. The interview focused on understanding rural hospital settings in terms of infrastructure, available facilities, and medical officers' perception of professional challenges in the management of poisoning cases. Results: Underreporting of poisoning cases in these primary health centers (PHCs) and transferring to higher hospitals without basic first aid provided was noted through interviews. Conclusion: Medical officers in rural PHCs lack the necessary training and knowledge required for the management of poisonings which is further worsened by lack of resources. There is a need to focus on poison management in continuous medical education. Training programs and education for medical officers are needs of the hour.
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We studied case series of 6 patients admitted with hypersensitivity and acute coronary syndrome. Kounis syndrome is local manifestation of generalised hypersensitivity reaction. Kounis syndrome (allergic angina) is not rare but rarely recognized and under-diagnosed. Serum tryptase is diagnostic biomarker of diagnose KS. Patients were treated with antihistaminic, adrenaline, steroid. In all patient having hypersensitivity reaction due to various triggers kounis syndrome should be suspected with high index of suspicion
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Coronary artery anomalies (CAAs) being a group of congenital disorders, present with highly variable manifestations andhave diverse pathophysiological manifestations. In middle aged to elderly patients, a coronary anomaly is often an incidental finding.We presenteda case of 65-year-old female with history of diabetes for past 9 years who presented to our emergency department with history of exertional chest pain for past 4 weeks. Anomalous origin of right coronary artery (RCA) from distal left circumflex artery (LCX) was observed on coronary angiography. Patient was managed with optimised medical therapy (OMT).
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Malignant pleural effusion (MPE) is one of the frequent and distressing conditions identified at the advanced stage of different malignant conditions. This problem seems to affect patients with lung and breast malignancies which contribute to the lower life quality. Less commonly MPE presents as a loculated fluid collection. We present an unusual case of cystic fluid collection in contact with the heart appearing similar to a pericardial cyst, but on cytological examination turned out to be loculated MPE. Furthermore, there was the presence of malignant fissural effusion. This text highlights the unusual location of this loculated MPE along with a few characteristic features to differentiate it from the benign pericardial cyst
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Background & objectives: Coronavirus disease 2019 (COVID-19) affects respiratory, gastrointestinal, cardiovascular and other systems disease. Studies describing liver involvement and liver function test (LFT) abnormalities are sparse from our population. This study was undertaken to estimate the LFT abnormalities in patients with COVID-19 in a tertiary care set up in India. Methods: In this retrospective study conducted at a tertiary care centre in Mumbai, India, all consecutive patients with proven COVID-19 by reverse transcriptase–PCR from March 23 to October 31, 2020 were enrolled. Of the 3280 case records profiled, 1474 cases were included in the study. Clinical characteristics, biochemical parameters and outcomes were recorded. Results: Overall 681 (46%) patient had deranged LFTs. Hepatocellular type of injury was most common (93%). Patients with deranged LFTs had more probability of developing severe disease (P<0.001) and mortality (P<0.001). Advanced age (P<0.001), male gender (P<0.001), diabetes mellitus (P<0.001), lower oxygen saturation levels at admission (P<0.001), higher neutrophil–lymphocyte ratio (P<0.001), history of diabetes mellitus and cirrhosiss were associated with deranged LFTs. Acute liver injury was seen in 65 (4.3%) cases on admission and 57 (3.5%) cases during hospital stay. On multivariate analysis for predicting mortality, age >60 yr serum creatinine >2 mg%, PaO2/FiO2 ratio ?200 and raised AST >50 IU/l (OR: 2.34, CI: 1.59-3.48, P<0.001) were found to be significant. Interpretation & conclusions: In COVID-19, LFT abnormalities were common, and derangement increased as severity progressed. The presence of deranged LFT worsens the clinical outcome and predicts in-hospital mortality.
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Zero Waste Administration refers to the general idea of waste administration which considers waste as an asset distributed during the interval period during the use of the asset. Zero waste methods can be applied to organizations, networks, modern areas, schools and homes because they involve many climate partners, yet also have specific angles. Suitable for adjustment insurance, reduction in assurance, additional power for ecological and outdoor climate and cyclic control. Asset boards and command at work are fundamental to task-by-task. As a result, the administration of zero waste is a practical abomination and a pervasive way of dealing with waste and property officials. Not withstanding the way that there are many invalid practice approaches and zero waste systems in the state of the art world, zero waste is a limit.
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This paper attempts to explore the determination of health and environmental outcomes of smart cities mission (MoHuA, India) and other urban development programs in India. It assesses the programs, evaluates their successes and failures, outlines their complications and gaps in addressing the urban health and environment concerns specific to India and its potential health and environmental impact. The paper further looks at how models adopted by the WHO, World Bank and urban health experts seek to address these gaps, which projects in India could potentially benefit from. The paper concluded by calling for what urban health experts call, 'descriptive urban health frameworks' which addresses some of the challenges posed by India's Smart Cities programs. This paper finally concludes by suggesting that a more qualitative and equity informed urban health framework is necessary to address the gaps that smart cities program in India fail to address. By highlighting issues of sanitation, water, housing, poverty, marginalization and inequalities, the paper calls for a more nuanced approach in addressing the needs of cities, within the context of urban health and environment.
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Background: UTI constitute a major public health problem in India accounting 2nd most common infection next to respiratory tract infection. They are responsible for increasing treatment cost and significant morbidity.Aim:-To determine the incidence of UTI, evaluation of pathogens responsible and their antimicrobial susceptibility pattern in the population.Methods:Urine samples were collected from 300 patients attending the OPD Patna medical college, Patna during the period of 18 months (January 2017 to June 2018) Antimicrobial sensitivity testing was done for the bacterial isolates present in the sample by Kirby- Bauer disc diffusion method. Only those samples were taken into consideration which develops count equal to or greater than 1*105CFU/ml as indicated by Kass.Results:Out of 300 samples collected 146 (48.66%)) yielded bacterial growth. Out of 146 culture isolates E.Coli was the most common pathogen followed by klebsiella, CoNS and staphylococcus. Antibiotic sensitivity was performed on all the isolates. It was observed that highest sensitivity was 49.31% to amikacin, gentamycin (45.89%), nitrofurantoin (38.35%) meropenem (27.39%).Conclusions:It was observed that high grade of resistance to ampicillin, cotrimoxazole, ciprofloxacin, cefuroxime, chloramphenicol, cefotaxime, cefazolin, amoxicillin + clavulanic acid and gentamycin is present as a result of misuse or improper use of antibiotic in the community. Hence urine culture is necessary for the diagnostic screening of UTI before the treatment.