ABSTRACT
Mitral stenosis (MS) is a progressive situation caused by obstruction of blood flow across the mitral valve from the left atrium to the left ventricle. It is one of the most common valvular heart lesions found during pregnancy. The chances of significant maternal and fetal morbidity and mortality are more in the case of severe MS. Balloon mitral valvuloplasty (BMV) is a life-saving procedure in pregnancy instead of surgical correction. We are presenting the case of a 24-week pregnant woman with severe MS. She developed pulmonary edema and had undergone successful BMV which allowed her to tolerate her pregnancy decently. It leads to a decrease in the left atrial pressure as well as pulmonary arterial pressure. The patient underwent normal delivery uneventfully. Antibiotics were used with proper consultation and the patient was treated conservatively with excellent maternal and fetal outcomes. BMV is turns out to be a life-saving therapy for severe MS complicated by pulmonary edema.
ABSTRACT
Background:Subclinical hypothyroidism (SCH) is a common endocrine disorder but spontaneous course of SCH in India is lacking. The aim of the study is to determine the spontaneous course of SCH and to identify the risk factors, which enhances the occurrence of overt hypothyroidism (OH).Method: This is a real world prospective observational study. 58 SCH were followed up six monthly for one year to determine the course of SCH.Results: After one year of follow up 11 (18.97%) patients progressed to OH. 37 (63.79%) remained in subclinical hypothyroid category. In 10 (17.29%) patients TSH (thyrotropin) normalized. Rate of progression (odds ratio: 4.58; 95% CI: 1.14, 18.28) was significantly more in anti-thyroid peroxidase (TPO) positive group as compared to anti-TPO negative group. Conclusions: This first data from India clearly shows that SCH has a variable course. Rate of progression to OH is high (18.97%) in Indian SCH patients. In a cohort of 58 patients followed for one year only the presence of anti-TPO antibody waspredictive of OH. The initial risk stratification can identify patients with SCH at greatest risk for progression to OH in which treatment is mandatory.
ABSTRACT
Scrub typhus is a seriously neglected life threatening disease in Asia and the islands of the Pacific and Indian oceans. The causative agent is Orientia tsutsugamushi, an obligate intra-cytosolic bacterium transmitted to vertebrate animals such as human or rodent by larval trombiculid mites (chiggers). Here, we conducted an outbreak investigation in Madhya Pradesh state in central India after sudden upsurge in scrub typhus cases and mortality in humans. Sixty-five live traps were placed for capturing the rodents. The captured rodent species were identified and the samples were subjected to nested PCR targeting 56kDa TSA gene. Analysis revealed for the first-time predominant circulation of Karp genotype in this region. The vector species involved in transmission is Leptotrobidium deliense. In conclusion, we reported the circulation of Karp strain in outbreak regions of Madhya Pradesh and suggest that public health monitoring and surveillance needs to be improved. Studies on antigenic diversity, association of strains with clinical spectrum and pathogenicity in the local setup will be essential for development of region-specific diagnostics and vaccines.
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Introduction: Regional anaesthesia in children was firststudied by August Bier in 1899 Intraoperative blockade ofthe neuraxis, whether by the spinal or epidural route providesexcellent analgesia with minimal physiologic alteration.This study was done with the primary aim to compare spinalanaesthesia with caudal anaesthesia in lower paediatric agegroup patients undergoing elective infraumbilical surgery forduration of analgesia and hemodynamic stability. We alsocompared the characteristics of sensory and motor block.Material and methods: In this study 100 patients whofulfilled the eligibility criteria were chosen and the procedurewas explained to the patients attendant. After obtainingwritten and informed consent, patients were randomizedinto two equal groups of 50 each. Group S was given spinalanaesthesia- hyperbaric bupivacaine (0.5%) in a dose of 0.5mg/kg was injected. Group C was given caudal block-0.5%plain bupivacaine 2mg/kg plus normal saline. Postoperativelypatients were observed for analgesia, sedation, hemodynamicand complications if any.Result: The sensory level achieved in all cases of group S wasT10 while in group C it was in 93%.Mean onset time, durationand regression of sensory block as well as for motor block washigher in caudal group than spinal group.The time required forfirst supplement was delayed in caudal group.Cries scale wasnot the limiting factor in both the groups.Conclusion: In short surgeries requiring immediate relaxationspinal anaesthesia is preferable while in surgeries withmoderately prolonged duration caudal is preferable.
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Background: Plantar Fasciitis is a frequent disorder involving the plantar fascia. Usually, syndromes that involvemanifestation of the typical heel pain are called plantar fasciitis. Common treatments can be divided into noninvasive and and invasive treatments, such as corticosteroid injection (CSI), botulinum toxin injection, platelet-rich plasma (PRP) injection and surgery. Methods: Total 80 patients were taken up for the study that completed the follow-up. Patients by random sampling were divided in two groups. Patients were divided in Conservative ultrasound therapy and Local Steroid Injections group of 40 patients each. Results: Treatment outcome was found almost similar in both treatment group, the betterment was found better with ultrasound with more duration of treatment but this is not statistically significant. Conclusion: Findings of our study suggest that As both treatment modalities are at par on comparison of their treatment outcome it is better to go for conservative approach.
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Background: Upper extremities are principally adapted for grasping or seizing activities. In individuals with spinal cord injury, they are additionally used for transfers, wheelchair propulsion, and daily living activities, putting additional strain on the joints. For this reason, it is essential to distinguish the effects of these increased demands in terms of prevalence of peripheral neuropathies in rehabilitated spinal cord injured population from developing countries. Methods: Spinal cord Injury patient with a neurological level below T2, who were independent in activities of daily living was monitored during the yearly follow up. Electrodiagnostic study of median, ulnar, radial nerve was graded in a scale of 0-2 with 0 being normal, 1 being neuropathy of one hand and 2 being an association of both the hands and the final conclusion was based on this study. Results: There were 45 wheelchair users, 5 walker users, 30 elbow crutch users, 10 subjects using sticks and one subject with a unilateral transtibial amputation using an axillary crutches. Thirty eight patients were using tricycle for independent mobility. Among 55 patients using wheel chair CTS was observed in 70% patients. In the same group 24% had ulnar neuropathy and 16% had radial neuropathy.Conclusion: Findings of our study suggest that upper limb compressive neuropathy was highly prevalent among the spinal cord injury patients. Further, current study recorded carpal tunnel syndrome was the most common neuropathy incorporated with paraplegia patients especially using wheel chair and crutches. We strongly advocate for the importance of the modification of in the vocational instruments like light weight or electrical wheelchair etc along with improvement in accessories like grip style, gloves etc to avoid the constant pressure and repetitive trauma to upper limb of paraplegia patients with spinal cord injury
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Background: The mandibular foramen, is the emerging point of the neurovascular bundle which makes it fundamental for performing anaesthetic techniques for desensitization of the mandible in oral surgery interventions. The knowledge of position of mandibular foramen is neccessary while anaesthetizing palate during periodontal procedures, tooth extractions and maxillofacial surgeries. Objective: The present study was carried out to identify the position and location of mandibular foramen in relation to the angle of mandible (gonial angle) in adult human mandibles of Indian origin . Materials and Methods: The study was conducted on 300 adult human dry skulls of Indian Population. Angle of mandible, Distance of mandibular foramen from angle of mandible and Angle of mandibular foramen with the base of mandible were measured. Measurements were done with Steel measuring tape and Mylometer. The data was Statistically analysed. Results and Conclusion: The Mean value of the angle of mandible (Gonial Angle) was 121.870 ± 6.220. The Mean value of the distance of mandibular foramen from angle of mandible was 22.78± 4.05 mm. The angle of mandibular foramen was Mean ± standard deviation of 82.240± 6.870. The morphometric correlation of the parameters analyzed in the mandibles showed a statistically significant Pearson correlation. Regression line was also derived.
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Clopidogrel, a non competitive inhibitor of adenosine diphosphate at the platelet receptors, is an anticoagulant drug practically insoluble in water. In order to improve the aqueous solubility of drug and its dissolution rate solid dispersions of clopidogrel were prepared with different proportions of the hydrophilic carrier PEG 6000. A two factor three level statistical design was used to quantify the influence of PEG 6000 and Clopidogrel on the dissolution profile of the solid dispersions prepared where PEG 6000 and Clopidogrel were chosen as independent variables while dissolution rate was chosen as dependent variable. Melt fusion method and solvent evaporation method were used for the preparation of solid dispersion. Results obtained showed that there was a significant increase in the dissolution rate of the drug as well as solubility of the drug in comparison to pure drug. Differential scanning calorimetry. X-ray diffraction and scanning electron microscopy analysis revealed the formation of solid dispersion of the drug with PEG 6000.
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Continuous depletion of the stratospheric ozone layer has resulted in an increase in ultraviolet-B (UV-B; 280-315 nm) radiation on the earth's surface which inhibits photochemical and photobiological processes. However, certain photosynthetic organisms have evolved mechanisms to counteract the toxicity of ultraviolet or high photosynthetically active radiation by synthesizing the UV-absorbing/screening compounds, such as mycosporine-like amino acids (MAAs) and scytonemin besides the repair of UV-induced damage of DNA and accumulation of carotenoids and detoxifying enzymes or radical quenchers and antioxidants. Chemical structure of various MAAs, their possible biochemical routes of synthesis and role as photoprotective compounds in various organisms are discussed.