Triple combination of palliative oral metronomic chemotherapy in recurrent and metastatic epithelial ovarian cancer: A retrospective study

Background: Ovarian cancer is a leading cause of death from gynecological cancer in the world and in India. This study aims to evaluate the efficacy and toxicity profile of oral metronomic chemotherapy (MCT) in the form of etoposide, cyclophosphamide, and tamoxifen in recurrent and metastatic ovarian cancer. Methods: This was a retrospective observational study that included those post?treatment patients who had the recurrent or metastatic disease after completion of treatment in 2018 at Regional Cancer Centre, Bikaner, Rajasthan. Forty patients who were unfit for further intensive intravenous chemotherapy were included. The oral MCT constituted etoposide, cyclophosphamide, and tamoxifen. Descriptive statistics and Kaplan?Meier analyses were performed. Progression?free survival (PFS) and overall survival (OS) were assessed. Results: Forty women with a median age of 62 (range: 35?80) years were enrolled in the study to receive oral MCT. The Eastern Cooperative Oncology Group?Performance Status (ECOG?PS) was 0�in 28 patients and 2�in 12 patients. The best clinical response rate post?oral MCT was seen in the first 4 months. Objective response was observed in 24 (60%) of patients in the form of stable disease (19, 47.5%) and partial response (5, 12.5%). Disease progression was observed in 10 (25%) of patients. The median follow?up was 6.4 months (4.5�2 months). The median estimated OS was 6.5 months. The median estimated PFS was 3.7 months. Nineteen (47.5%) patients had grade?I/II mucositis. Grade?III/IV mucositis were observed in 9 (22.5%) patients. Thirty?seven (92.5%) patients died at the end of the study at 1 year. Dose reduction was required in 15 (37.5%) patients. Conclusion: Oral MCT was found to be an effective and well?tolerated regime with good symptomatic control and low?moderate toxicity profile in patients with relapsed and metastatic ovarian cancer. However, 22% of patients showed grade?III/IV thrombocytopenia.

MICROBIAL PROFILE AND ANTIBIOTIC SUSCEPTIBILITY OF BACTERIAL PATHOGENS ISOLATED FROM PAPER CURRENCIES CIRCULATING IN SOME RESTAURANTS AND BUTCHERIES IN HAWASSA, SIDAMA, ETHIOPIA, 2020-21

Currency notes could play a signicant role in transmitting pathogenic microorganisms amongst individuals in the society. This study was aimed to determine the microbial prole and Antibiotic susceptibility of bacterial pathogens isolated from Ethiopian paper notes in circulation. 64 currency paper notes of different denomination were tested for bacterial contamination using standard microbiological methods. Antibiotic susceptibility proles of the isolates were determined with approved methods. Results were analyzed using descriptive statistics. Overall mean AMBC was 4.08 log units, with the highest 6.58 log units recorded from denomination 5 followed by 4.50, 3.03, 2.20 log units from denominations 10, 50 and 100 respectively. Total Coliforms (TC) displayed the same pattern with the highest mean counts of 6.52 log units, from denomination 5 and lowest counts of 2.19 log units from denomination 100. Out of 64 currency notes, 35 (54.7%) were contaminated with bacteria. The predominant bacteria isolates were E. coli (60.5%), Salmonella spp. (23.6%) and Shigella spp. (13.2%). Each isolate was resistant to four or more antibiotics tested. All isolates were resistant against Cefepime and Tetracycline and sensitive to Ceftriaxone. This study revealed that currency notes are contaminated with pathogenic bacteria and in most cases these bacterial isolates were resistant to commonly prescribed antibiotics. Therefore, contaminated notes are identied as potential public health threat, because pathogens can be spread by circulating the notes and become source of infection. Awareness creation is important among public in this regard.

Screening practices for breast and cervical cancer and associated factors, among rural women in Vellore, Tamil Nadu

Background: Population-based screening coverage for breast and cervical cancer screening in the community is inadequately reported in India. This study assessed screening rates, awareness, and other factors affecting screening, among rural women aged 25� years in Vellore, Tamil Nadu. Methods: Women aged 25� years, from five randomly selected villages of a rural block were included in this cross-sectional study in Vellore, Tamil Nadu. Households were selected by systematic random sampling, followed by simple random sampling of eligible women in the house. A semi-structured questionnaire was used to assess screening practices, awareness, and other factors related to cervical and breast cancer. Results: Although 43.8% and 57.9% were aware of the availability of screening for cervical and breast cancer respectively, screening rates were only 23.4% (95% confidence interval [CI]: 18.4-28.4%) and 16.2% (95% CI: 11.9-20.5%), respectively. Adequate knowledge (score of ?50%) on breast cancer was only 5.9%, with 27.2% for cervical cancer. Only 16.6% of women had ever attended any health education program on cancer. Exposure to health education (breast screening odds ratio [OR]: 6.89, 95% CI: 3.34-14.21; cervical screening OR: 6.92, 95% CI: 3.42-14.00); and adequate knowledge (breast OR: 4.69, 95% CI: 1.55-14.22; cervix OR: 3.01, 95% CI: 1.59-5.68) were independently associated with cancer screening. Conclusion: Awareness and screening rates for breast and cervical cancer are low among rural women in Tamil Nadu, a south Indian state with comparatively good health indices, with health education being an important factor associated with screening practices.

To Compare the effect of Chloroprocaine and Chloroprocaine with Fentanyl for Spinal Anaesthesia: A Prospective Randomised Double Blind Study.

Background: Usually for lower abdomen and lower limb short surgical procedures, spinal anaesthesia is a reliable and safe anaesthesia technique.2-chloroprocaine (2-CP) is an amino-ester local anaesthetic with a very short half-life. Adjuvants are required with short acting local anaesthetic for spinal anaesthesia to prolong analgesia. Aims and Objectives: The present study was conducted to analyse the effect of 2-CP alone and with fentanyl combination in spinal anaesthesia for short surgical procedures in terms of onset of block, adequacy of anaesthesia, analgesia and recovery. Materials and Methods: The study was conducted in our hospital in 60 patients undergoing lower abdomen and lower limb short surgical procedures under spinal anaesthesia with either 2-CP or 2-CP and fentanyl (group I or group II) after randomisation into two groups. Spinal anaesthesia characteristics of sensory and motor block, duration of analgesia were noted and appropriate statistical analysis was performed. Results: The onset of sensory and motor block was faster in group II[5.00 ± 3.19 vs 7.156 ± 3.38 min. (p= 0.0138) and 8.03 ± 5.65 vs 11.03 ± 3.97 min. (p= 0.021)] than in group I, and duration of effective analgesia was prolonged in group II (147.63 ± 40.71 vs 130.40 ± 50.85 min with p value of 0.0002)as compared to group I. Eleven patients in group I required analgesic supplementation in the intraoperative period. Conclusion: The patients undergoing short surgical procedures of lower abdomen and lower limb under spinal anaesthesia with short acting local anaesthetic 2-CP with fentanyl as an additive provides rapid onset of sensory and motor block and prolonged duration of analgesia.

Assessment and comparison of distal radial artery diameter in anatomical snuff box with conventional radial artery before coronary catheterization

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

Management of Hypertension in Patients with Diabetes: A Comprehensive Review of the Perceptions and Practices of Health Care Providers in India

Objectives: This study evaluated the perception and practices of health care providers (physicians, diabetologists, and endocrinologists) regarding the treatment of hypertension in patients with diabetes in India. Methods: Health care providers throughout India who treated patients with diabetes and hypertension were invited to participate in an online survey and periodic 21 virtual meetings. They were questioned about their perception and practices in managing these patients, and strategies to improve blood pressure (BP). Results: The online survey was completed by 2,513 health care providers, and 344 participated in virtual meetings. More than 50% reported that 31–50% of their patients with diabetes also had hypertension. Home BP monitoring was recommended by 88%, and lifestyle modifications were consistently recommended. Choice of antihypertensive treatment varied based on comorbidities, and a renin–angiotensin system blocker plus a calcium channel blocker (CCB) was the most common combination for dual antihypertensive therapy. Suggested strategies to improve BP control included patient awareness/education, lifestyle modifications, better follow-up/monitoring, and optimization of therapy. Conclusion: Indian health care providers were aware of clinical recommendations and practices regarding treatment of patients with diabetes and hypertension, and generally make clinical decisions consistent with current guidelines. Optimization of care for these patients is essential to reduce cardiovascular disease risk and improve patient outcomes.

Indian Academy of Pediatrics Consensus Guidelines for Probiotic Use in Childhood Diarrhea

Justification: Several probiotic species and strains, single or combined, have been evaluated in childhood diarrheal disorders, and recommendations have ever been changing as newer trials are published. Therefore, there is a need to develop a guideline for Indian children describing the current role of probiotics in clinical practice. Objectives: To develop a guideline for the use of probiotics in children with diarrhea. Process: A national consultative group (NCG) was constituted by the Indian Academy of Pediatrics (IAP), consisting of subject experts. Sub-topics were allotted to various experts as paired groups for detailed review. Members reviewed the international and Indian literature for existing guidelines, systematic reviews, meta-analyses and trials. Thereafter, two virtual structured meetings of the group were held on 2nd and 22nd August, 2020. The management guidelines were formulated by the group and circulated to the participants for comments. The final guidelines were approved by all experts, and adopted by the IAP executive board. Recommendations: The NCG suggests Lactobacillus GG as a conditional recommendation with low-to-moderate level evidence or Saccharomyces boulardii as a conditional recom-mendation with very low-to-low level evidence as adjuvant therapy in acute diarrhea. The NCG also recommends the use of combination probiotics in neonatal necrotizing enterocolitis (NEC), as these reduce the risk of NEC stage II and above, late-onset sepsis, mortality and also time to achieve full feeds. The NCG does not recommend the use of any kind of probiotics in the therapy of acute dysentery, persistent diarrhea, Clostridium difficile diarrhea and chronic diarrheal conditions such as celiac disease, diarrheapredominant irritable bowel syndrome and inflammatory bowel disease in children. Risk of antibiotic-associated diarrhea (AAD) is high with some antibiotics and most of these cases present as mild diarrhea. The NCG recommends probiotics only in special situations of AAD. L. rhamnoses GG or S. boulardii may be used for the prevention of AAD. VSL#3, a combination probiotic, may be used as an adjuvant in active pouchitis, and for prevention of recurrences and maintenance of remission in pouchitis.

Founder BRCA1 mutations in Nepalese population

Background@#Founder mutation is a heritable genetic alteration observed with high frequency in a geographically and culturally isolated population where one or more ancestors becomes the forebearer of the altered gene. The current study reports two founder mutations in the BRCA1 gene in the Nepalese people. @*Methods@#Germline BRCA testing in all surface epithelial ovarian cancers and the selected case of breast, prostate, and pancreatic cancers has been the standard practice from 2016 to 2021. One thousand one hundred thirtythree probands were screened for germline BRCA variants by next generation sequencing. The variants were classified as per the American Society of Medical Genetics and Genomics recommendations. Pathogenic (class V) and likely pathogenic (class IV) were considered clinically relevant and utilized for cascade screening. @*Results@#Nepalese population made up a subcohort of 5.12% (58/1,133) of probands tested for germline BRCA1/2 variants. Twenty-seven of these 58 tested harbored pathogenic genetic alterations in BRCA1/2 genes, with 23 being BRCA1 mutant. Sixteen of 23 BRCA1 mutant cases shared one common pathogenic mutation c.2214_2215insT (p.Lys739Ter) (NM_007294.4). Additionally, a second highly recurrent mutation in BRCA1 gene c.5068A>T (p.Lys1690Ter) (NM_007294.4) was noted in six patients from this population. @*Conclusions@#The overwhelming abundance of the above two variants in a geographically confined population confers these two genetic alterations a status of founder mutations amongst the people of Nepal. A more extensive population-based study to reaffirm these findings will help establish a dual site-specific germline testing similar to the “Multisite-3-assay” in Ashkenazi Jews as the primary screening tool, especially in a resource-constrained environment.

Telemedicine during coronavirus disease-19 pandemic: a paradigm shift in cardiovascular care / La telemedicina durante la pandemia del COVID-19: un cambio de paradigma en la atención cardiovascular

Abstract Introduction: Severe acute respiratory syndrome due to coronavirus disease (COVID-19) has overwhelmingly affected the health-care systems globally. Delivering cardiovascular care has become unusually difficult both for caregivers and physicians in these unprecedented times. Methods: We briefly reviewed how cardiac care can be delivered to patients while limiting the exposure of both patients and healthcare workers through telemedicine services. We made a comparison at our institute of outpatient services through routine and telemedicine visits. Results: We found that telemedicine can be an equally effective alternative cardiac care during the times of pandemic with no significant difference in patients profile admitted through telemedicine services. Conclusions: We concluded that telemedicine can prove to be an effective tool in delivering cardiac care by limiting exposure of both patients and physicians with better triage of cardiac patients in the situation of COVID-19 pandemic and may complement to regular cardiac care in routine times.

Resumen Introducción: El síndrome respiratorio agudo grave dado por el COVID-19 ha afectado de manera abrumadora a los sistemas de salud a nivel mundial. La prestación de servicios de atención cardiovascular se ha tornado inusualmente difícil tanto para los cuidadores como para los médicos en estos tiempos inéditos. Métodos: Realizamos una revisión breve de cómo se puede brindar atención cardíaca a los pacientes a la vez que se limita la exposición tanto de pacientes como del personal de la salud a través de los servicios de telemedicina. Comparamos los servicios ambulatorios habituales con las visitas de telemedicina en nuestro instituto. Resultados: Encontramos que la tele medicina puede ser una alternativa igualmente efectiva de atención cardíaca durante tiempos de pandemia, sin ninguna diferencia significativa en el perfil de los pacientes ingresados a través de los servicios de telemedicina. Conclusiones: Concluimos que la telemedicina puede convertirse en una herramienta efectiva para proporcionar atención en salud cardíaca al limitar la exposición tanto de pacientes como de médicos con un mejor triage de pacientes cardíacos en el contexto de la pandemia por COVID-19, y puede llegar a ser un complemento de la atención cardíaca habitual en tiempos normales.

Autoimmune Sclerosing Cholangitis in Children: A Prospective Case-Control Study / 대한소아소화기영양학회지

Purpose@#In children overlap of autoimmune hepatitis (AIH) and primary sclerosing cholangitis is labelled as autoimmune sclerosing cholangitis (ASC). The only prospective pediatric study showed a high prevalence of ASC by using endoscopic retrograde cholangiopancreatography. Aims of our study were to find the prevalence of ASC by using magnetic resonance cholangiography (MRC) in AIH and in non-AIH cirrhosis and to compare clinical presentation and outcome of AIH and ASC. @*Methods@#Prospectively we did MRC in 38 children with AIH (cases) and 19 disease controls (Wilson disease). Multiple biliary strictures with proximal dilatation on MRC were taken as definitive changes of ASC. Detail clinical, laboratory parameters, liver histopathology and treatment outcome were recorded. @*Results@#The median age of cases was 11.5 (3–18) years, 22 (57.9%) were girls and 28 (73.7%) were diagnosed as type 1 AIH. MRC was done in 11 children (28.9%) at the time of diagnosis and in 27 (71.1%) after a median follow-up of 2.5 (0.3–10) years. Abnormal MRC changes were seen in 14/38 (36.8%) of AIH and 8/19 (42.1%) of controls. However, definite changes of ASC were present in four (10.5%) children in AIH and none in controls. None of the clinical, laboratory, histological parameters and treatment response were significantly different between ASC and AIH groups. @*Conclusion@#The prevalence of ASC in children with AIH was just 10.5%. We suggest MRC in select group with cholestatic features, inflammatory bowel disease and in those who showed poor response to immunosuppression instead of all children with AIH.

Autoimmune Sclerosing Cholangitis in Children: A Prospective Case-Control Study / 대한소아소화기영양학회지

Purpose@#In children overlap of autoimmune hepatitis (AIH) and primary sclerosing cholangitis is labelled as autoimmune sclerosing cholangitis (ASC). The only prospective pediatric study showed a high prevalence of ASC by using endoscopic retrograde cholangiopancreatography. Aims of our study were to find the prevalence of ASC by using magnetic resonance cholangiography (MRC) in AIH and in non-AIH cirrhosis and to compare clinical presentation and outcome of AIH and ASC. @*Methods@#Prospectively we did MRC in 38 children with AIH (cases) and 19 disease controls (Wilson disease). Multiple biliary strictures with proximal dilatation on MRC were taken as definitive changes of ASC. Detail clinical, laboratory parameters, liver histopathology and treatment outcome were recorded. @*Results@#The median age of cases was 11.5 (3–18) years, 22 (57.9%) were girls and 28 (73.7%) were diagnosed as type 1 AIH. MRC was done in 11 children (28.9%) at the time of diagnosis and in 27 (71.1%) after a median follow-up of 2.5 (0.3–10) years. Abnormal MRC changes were seen in 14/38 (36.8%) of AIH and 8/19 (42.1%) of controls. However, definite changes of ASC were present in four (10.5%) children in AIH and none in controls. None of the clinical, laboratory, histological parameters and treatment response were significantly different between ASC and AIH groups. @*Conclusion@#The prevalence of ASC in children with AIH was just 10.5%. We suggest MRC in select group with cholestatic features, inflammatory bowel disease and in those who showed poor response to immunosuppression instead of all children with AIH.

Association of vitamin D deficiency and bone mass with liver and heart iron overload in transfusion dependent thalassemia

Background: Transfusion dependent thalassemia patients are reported to have Vitamin D insufficiency/deficiency in many countries. Vitamin D hydroxylation occurs in the liver; whether liver iron overload interferes with this step has not been addressed till date. This study helps to establish an association between liver iron concentration (LIC) and heart iron concentration (MIC) with vitamin D levels and Bone Mass Density in these patients.Methods: A cross sectional study was done by including transfusion dependent Thalassemia patients (TM) if they had an assessment of Liver and cardiac iron done by T2*MRI and bone mineral density by DEXA. Clinical data regarding age, gender, type of iron chelation therapy and laboratory data of S. ferritin and Vitamin D was collected. Data was assessed using appropriate statistical methods.Results: Among 40 TM patients were taken and mean age was 17.6 years. Vitamin D deficiency was identified in 26(65%). 20 out of them had an LIC>7mg/g DW and 6 had MIC>1.65mg/g DW. There was a significant association between LIC>7mg/g and vitamin D level<20 ng/ml and a significant inverse correlation between LIC and vitamin D, suggesting that liver iron overload may indeed affect vitamin D metabolism. Osteopenia was present in 32.5% and osteoporosis was present in 27.5 % of all TM patients. Reduced Bone Mass Density was also found to be linked with iron over load.Conclusions: Regular monitoring of vitamin D levels and supplementation is required in patients with severe liver and heart iron load. More studies are needed to confirm these results.

Study of pattern and management strategies of solid visceral injuries in blunt trauma abdomen in tertiary care centre

Background: Blunt trauma abdomen is a leading cause of morbidity and mortality among all age groups. In spite of the best techniques and advances in diagnostic and supportive care, the morbidity and mortality still remain large. The aim was to evaluate pattern and management strategies of solid visceral injuries in blunt trauma abdomen patients.Methods: This was a prospective study on 100 consecutive patients admitted in Department of General Surgery at a tertiary care center with an antecedent history of blunt abdominal injury. All patients proven to have penetrating injury and hollow viscus injury were excluded. The pattern of injury, presentation and parameters associated with management strategies were evaluated.Results: In the present study, solid viscera injury in blunt trauma abdomen is more common in age group 21-30 years (43%) with male predominance (92%). RTA (75%) were the most common mode of injury followed by fall. Most common clinical presentation was abdominal pain (86%) followed by tachycardia (34%) and hypotension (6%). Most common viscera injured is liver (48.2%) followed by spleen (36.7%), kidney (12.3%) and pancreas (2.8%). Majority of patients were managed conservatively (84%).Conclusions: It was concluded from the study that irrespective of the solid organ injury in blunt trauma abdomen, patients can be managed conservatively due to aggressive resuscitation with supplement drug therapy, use of analgesia or sedation in ICU setup and close monitoring. Patients are grossly hemodynamically unstable at presentation do require intervention either immediate or in due course of time.

Evaluation of pattern and prognostic factors of head injury cases in a tertiary care centre

Background: Head injury is a major public health problem worldwide and requires appropriate attention both regionally and globally. This study was done to find the patterns and to evaluate prognostic factors for final outcome of cranio-cerebral trauma.Methods: A prospective study of 200 cases of head injury was conducted in a tertiary care hospital during one year duration. Apart from patient’s demographic profile detailed history and examination was recorded. Final outcome of all patients was noted at discharge and during follow up, various prognostic factors were studied by taking Glasgow outcome scale (GOS) at 3 months of head injury.Results: This study included 156 (78%) males and 44 (22%) females with average age of 35.95 years. Assault followed by RTI was the main cause of TBI. The factors which correlated with poor prognosis are presence of increasing age, less GCS at admission, alcohol intoxication and multiple lesions on CT scan.Conclusions: Prognostication of patients with head injury will help to provide timely multimodality approach which will ultimately help in improving outcome of these patients.

Single cell oil production by a novel yeast Trichosporon mycotoxinivorans for complete and ecofriendly valorization of paddy straw

Background: Oleaginous yeasts can be grown on different carbon sources, including lignocellulosic hydrolysate containing a mixture of glucose and xylose. However, not all yeast strains can utilize both the sugars for lipogenesis. Therefore, in this study, efforts were made to isolate dual sugar-utilizing oleaginous yeasts from different sources. Results: A total of eleven isolates were obtained, which were screened for their ability to utilize various carbohydrates for lipogenesis. One promising yeast isolate Trichosporon mycotoxinivorans S2 was selected based on its capability to use a mixture of glucose and xylose and produce 44.86 ± 4.03% lipids, as well as its tolerance to fermentation inhibitors. In order to identify an inexpensive source of sugars, nondetoxified paddy straw hydrolysate (saccharified with cellulase), supplemented with 0.05% yeast extract, 0.18% peptone, and 0.04% MgSO4 was used for growth of the yeast, resulting in a yield of 5.17 g L−1 lipids with conversion productivity of 0.06 g L−1 h−1 . Optimization of the levels of yeast extract, peptone, and MgSO4 for maximizing lipid production using Box­Behnken design led to an increase in lipid yield by 41.59%. FAME analysis of single cell oil revealed oleic acid (30.84%), palmitic acid (18.28%), and stearic acid (17.64%) as the major fatty acids. Conclusion: The fatty acid profile illustrates the potential of T. mycotoxinivorans S2 to produce single cell oil as a feedstock for biodiesel. Therefore, the present study also indicated the potential of selected yeast to develop a zero-waste process for the complete valorization of paddy straw hydrolysate without detoxification

Genome-wide analysis of various paralogs of aminopeptidase N (APN) gene in Anopheles gambiae (Diptera: Culicidae)

Malaria continues to be a life threatening infectious disease throughout the tropical region of the world.aminopeptidase N1 (APN1) is one of the best choices for developing new Malaria Transmission-blockingvaccines. In this study an attempt has been made to overview genome-wide identification of APN genes inAnopheles gambiae. A total of eighteen A. gambiae APN sequences were found that contain conserved HEXXHand GAMEN signature sequences, indicate that large numbers of APN isomers present in mosquitoes. MultipleAPN paralogs exist as a gene cluster may propose that huge synthesis of APNs is required for rapid digestion ofpeptides over a brief period. Gene structure study shows high sequence variations among them. Protein–proteininteractions show that APN1 is highly connected protein, supporting their role as hub with other five types ofAPNs involved in glutathione metabolism, act as hub protein and disruption of one of these proteins may affectthe whole pathway

Priapism: a rare presentation in chronic myeloid leukemia

Priapism is a rare presenting feature of Chronic Myeloid Leukemia (CML). It is an urological emergency which requires urgent treatment to prevent long term complications, in particular erectile dysfunction. Author report a case of 18 year old male presenting with persistent painful erection of penis for around 14 hours. The patient underwent immediate irrigation and decompression of priapism in emergency and was started on cytoreductive therapy. During hospitalization, peripheral blood smear and bone marrow aspiration confirmed the diagnosis of CML

Concurrent dengue and typhoid infection: study from a tertiary care centre in Muzaffarnagar, India

Background: Acute febrile illness is a common presenting complaint during the rainy season. Rains predispose to both water and vector borne diseases. Co-infection of dengue with malaria, leptospirosis, typhoid, scrub typhus and other arboviral diseases can occur in endemic areas. Such dual infections are difficult to diagnose and create a diagnostic dilemma for the treating physician. Here in this study authors attempt to find out rates of concurrent dengue and typhoid infection.Methods: This retrospective study was done between August to November 2017. 403 patients presenting with acute febrile illness were studied. Diagnosis of dengue was done by rapid card test detecting NS1 antigen, IgM and IgG antibodies. Serodiagnosis of Salmonella infection was done by tube Widal test.Results: : Out of 403 febrile sera samples tested 154 (38.2%) were positive for dengue (either NS1 antigen or IgM antibodies or both), 71(17.6%) were positive for Widal test O and H titres ≥1:160) and 28 (6.9%) were positive for both dengue as well as Salmonella (Widal test).Conclusions: Acute febrile illnesses with diagnostic dilemma may be seen in cases of co-infection. Only better clinical judgement and right choice of laboratory tests can diagnose these diseases timely and prevent fatal outcomes.

Pattern and Etiology of Patients with Gastrointestinal Perforations: An Observational Prospective Study

Introduction: Perforation peritonitis is the most commonsurgical emergency encountered all over the world. Theobjective of the study was to highlight the spectrum ofperforation peritonitis as encountered in a tertiary care centrein haryana.Material and methods: It was observational prospectivestudy of 100 cases of perforation peritonitis treated in thedepartment of surgery. The maximum number of patients inthe present study were in age group of 21-30 years (26%) witha mean age was 31 years. Male female ratio was 8.09:1.Results: The most common etiology of perforation peritonitiswas peptic ulcer disease (41%) followed by enteric fever (15%)and tuberculosis (13%)The most common site of perforationin this series was gastroduodenal (43%) followed by terminalileum (30%). Mortality rate was 5% and significantly high inpatients coming to the hospital after 24 hours.Conclusion: Early recognition of symptoms and referral isvery important in reducing mortality and morbidity

A Study on Prevalence, Complications and Management of Septic Arthritis

Septic arthritis is also known as joint infection or infectious arthritis or pyogenic arthritis, is the invasion of a joint by an infectious agent resulting in joint inflammation. It is one of the major orthopedic problem. The morbidity and mortality is very high if the treatment is delayed. The causes includes bacteria, viruses, fungi and parasites. Aim of the study: To study the prevalence ethology and complications and management of septic arthritis in our department. Methods: We have studied 80 Acute septic arthritis cases out of these 25 are females 15 are in pediatric age group. Results: Results depends on early diagnosis and treatment, delayed diagnosis and treatment may have high morbidity and mortality. In our study 52 patients (64.78%) had excellent prognosis, 12 patients (15.4%) had good prognosis, 8 patients (9.85%) had poor prognosis and 8 patients (9.85%) are died because of complications. Conclusion: Acute Septic arthritis is still a major health problem in developing countries and India also. The morbidity and mortality is very high in rural part of India and it is mainly because of delayed diagnosis and treatment. So there is need to improve medical facilities in rural part of India.