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Purpose: Retinopathy of prematurity (ROP) is a leading cause of childhood blindness. Capturing serial daily postnatal weight gain can act as an innovative, low?cost method of risk stratification. We aim to study the relation between weight gain in infants and occurrence of ROP. Methods: The prospective, observational study was conducted on 62 infants. ROP screening was done based on the Rashtriya Bal Swasthya Karyakram (RBSK) criteria. Infants were classified into no ROP (n = 28), mild ROP (n = 8), and treatable ROP (n = 26) groups. Average daily postnatal weight gain was measured and its relation to development of ROP was studied. All statistical calculations were done using Statistical Package for the Social Sciences (SPSS) 21 version (SPSS Inc., Chicago, IL, USA) statistical program for Microsoft Windows. Results: Mean rate of weight gain in no ROP group, mild ROP group, and treatable ROP group was 33.12, 27.19, and 15.31 g/day, respectively (P = 0.001). Mean gestational age and birth weight in treatable group (n = 26) were 31.38 weeks and 1572.31 g, respectively. Receiver operating curve analysis revealed a cutoff of 29.33 g/day for ROP and 21.91 g/day for severe ROP. Conclusion: We concluded that, babies with poor weight gain of below 29.33 g/day are at high risk for ROP and babies with wight gain of 21.91 g/day are at high risk for severe ROP. These babies should be followed meticulously. So, the rate of weight gain of a preterm can help us to prioritize babies.
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Background & objectives: Celiac disease (CD) is a genetic immune mediated disorder characterised by gluten intolerance. This single centre study, from north India was aimed to assess the clinical, serological and histological profile of CD in a large cohort of children and the changing trends in its presentation. Methods: A review of clinical details of CD children diagnosed between 2000 and 2019 and currently on follow up was performed. Information on demography, symptoms, associated conditions, serology, biopsy findings and gluten-free diet were analyzed. Results: The mean age (±standard deviation) of 891 children included in the study, at onset and at diagnosis was 4.0±2.7 and 6.2±3.1 yr, respectively. Growth faltering, abdominal pain, abdominal distension and diarrhoea were presenting symptoms in 70, 64.2, 61.2 and 58.2 per cent, respectively. A positive family history of CD was present in 14 per cent and autoimmune conditions in 12.3 per cent of children. Thyroid disorders were seen in 8.5 per cent of children and Type 1 diabetes mellitus (T1DM) in 5.7 per cent. The duration of breastfeeding had a weak positive correlation with age at onset and diagnosis of CD (P<0.001). Non-classical CD was significantly more common in children aged >10 yr and in those presenting after 2010 (P<0.01). T1DM and hypothyroidism occurred more frequently in non-compliant children. Interpretation & conclusions: This was the largest single centre study, pertaining to the presentation and follow up of CD in children. Infants and young children were more likely to present with classical symptoms of diarrhoea, abdominal distension and growth failure while older children presented with non-classical CD. There was a trend towards non-classical forms of CD in recent years.
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Ever-evolving modern day cataract extraction techniques have been accompanied by the use of smaller quantities and less invasive methods of anesthesia. Topical anesthesia is routinely used for phacoemulsification. However, peribulbar block or some modification of it is used for anesthesia in manual small-incision cataract surgery (MSICS) by most practitioners. The authors describe a technique using a combination of 1.5�milliliters of anesthetic mixture given subconjunctivally and supplemented with commercially available intracameral anesthetic and mydriatic for MSICS. It is possible to get high level of anesthetic effect and ease of surgery with this technique though there is a small learning curve. Several modifications from topical phacoemulsification like two side ports six o抍lock hours apart make this surgery easy to adapt to. No special instrumentation is required. It gives adequate analgesia and anesthesia to complete the surgery. a minimalistic anesthetic approach in MSICS can be used with enhanced safety and by avoiding usual complications of traditional peribulbar and retrobulbar anesthesia.
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Background: Dysregulated serum levels of Mannan binding lectin (MBL) has a probable role in Systemic Lupus Erythematosus (SLE) pathogenesis. Objective: To evaluate the association between serum MBL levels in SLE patients from western India with the severity of disease Methods: SLE patients (n=70) from Western India were included. Based on MBL levels, patients were classified into four categories, viz. low (<100 ng/ml), mild (100-500 ng/ml), moderate (500-1000 ng/ml) and high (>1000 ng/ml). Correlation of serum MBL levels with disease severity was assessed using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). MBL levels and circulating immune complex levels were detected by ELISA. C3, C4 and CRP levels were detected by nephelometer. Results: Serum MBL levels of SLE patients (1954 ± 202.4 ng/ml) was lower than that of healthy controls (2388 ± 205.0 ng/ ml). There was no significant correlation between MBL levels with severity of SLE on the basis of ACR criteria and SLEDAI scores (p> 0.05). No significant difference was observed among MBL levels and SLE patients with (1847 ± 246.7) or without (1900 ± 246.8) Lupus Nephritis. SLE patients without infections (n= 33) had low MBL levels (1700 ± 301.0 ng/ ml) as compared with SLE patients with infection (n= 37) (2189 ± 284.6 ng/ ml) (p=0.30) Conclusion: Present study indicated that low MBL levels were not associated with disease severity, haematological manifestations and infections among SLE patients from Western India.
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Animal models are useful in glaucoma research to study tissue response to wound healing. Smaller animals such as rats offer additional advantages in terms of availability of detection antibodies and microarrays with cheaper maintenance costs. In this study, we describe a glaucoma filtering surgery (GFS) model in adult Sprague–Dawley rats by performing a sclerostomy using a 26?G needle and additionally placing a silicone tube (27 G) connecting the anterior chamber to the subconjunctival space to maintain a patent fistula for the flow of aqueous humor, thus providing a more definitive bleb. This technique will be useful in identifying and modifying newer targets in the wound healing process in order to improve surgical outcomes following GFS
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The complete picture regarding transmission modes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unknown. This review summarises the available evidence on its transmission modes, our preliminary research findings and implications for infection control policy, and outlines future research directions. Environmental contamination has been reported in hospital settings occupied by infected patients, and is higher in the first week of illness. Transmission via environmental surfaces or fomites is likely, but decontamination protocols are effective in minimising this risk. The extent of airborne transmission is also unclear. While several studies have detected SARS-CoV-2 ribonucleic acid in air samples, none has isolated viable virus in culture. Transmission likely lies on a spectrum between droplet and airborne transmission, depending on the patient, disease and environmental factors. Singapore's current personal protective equipment and isolation protocols are sufficient to manage this risk.
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Humans , COVID-19 , Hospitals , Infection Control/methods , Personal Protective Equipment , SARS-CoV-2ABSTRACT
Stratified mucin-producing intraepithelial lesion (SMILE) is an intraepithelial lesion with overlapping features of the high-grade squamous intraepithelial lesion (HSIL) and adenocarcinoma in situ (AIS). Currently, it is well described in the cervix. We present a case showing similar SMILE-like lesions in the polypectomy specimen from the anal canal along with invasive adenocarcinoma components. This lesion showed an immuno-profile characteristic of a SMILE lesion described in the cervix, such as p63 negativity, high ki67 index, and nuclear positivity for p16. It might be arising from the Human papillomavirus prone transitional region of the anal canal as described in the cervix. However, we could not assure this association and etiological link due to insufficient material in the formalin-fixed paraffin-embedded block. Notwithstanding, we strongly suggest that the HPV is the main driver for this SMILE-like lesion similar to what is described in the cervix. To our knowledge, this is the first case report of a SMILE lesion in the anal canal. Further studies will be required to elucidate the underlying pathogenetic mechanism of SMILE-like lesions described in the anal canal.
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Humans , Male , Adult , Anal Canal/pathology , Carcinoma in Situ , Adenocarcinoma , PolypsABSTRACT
Background: Hepatitis virus infections have many serious consequences like chronic hepatitis, fulminant hepatitis, liver cirrhosis, hepatocellular carcinoma and liver cancer. Serological test is thus necessary to identify hepatitis virus in the body. An observational study was conducted with an objective to detect hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (HCV) antibodies by rapid card tests and to find the prevalence of co-infection with hepatitis B and hepatitis C viruses from January 2019 to June 2019.Methods: Blood samples were received from patients irrespective of age and sex, constituted the material for the present study. All samples were tested on hepacard and tri-dot card for the detection of hepatitis B virus and hepatitis C virus and results were interpreted as per Clinical Laboratory Standards Institute guidelines.Results: Out of 3488 samples, 254 samples were positive for hepatitis virus infection. Out of these 254 samples positive for hepatitis viruses, 22 (0.6%) patients were positive for hepatitis B virus and 232 (6.6%) patients were positive for hepatitis C virus. Only 2 (0.7%) of these patients showed co-infection with both viruses.Conclusions: Male patients showed more positivity of hepatitis virus as compared to females. Patients were more from outpatient department (OPD) as compared to inpatient department (IPD). Hepatitis virus infection was found to be highest in the age group 21-40 and lowest in the age group above 80 years. Both the co-infected patients were males and from IPD.
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Background: Management of critically ill obstetric patients involve intensive monitoring in intensive care unit. In present scenario there are significant number of obstetric patients with sepsis, tropical diseases and medical illness that require ICU care. The aim of this study was to evaluate in more detail the non-haemorrhagic causes of obstetric ICU admissions and to identify and adopt high risk strategies as prime learning objective.Methods: It is a prospective ongoing study conducted in 50 patients in SGRDUHS, Amritsar from December 2016 to October 2019, who were admitted in obstetric ICU, out of them 30 cases were attributed to non-haemorrhagic obstetric causes. All demographic parameters along with gestational age, diagnosis on admission, intervention done prior to shift to ICU and details of treatment given in ICU were evaluated. Patient outcome, review of mortality and area of improvement were also noted.Results: Majority of the patient (70.1%) were admitted in 3rd trimester. Obstetric sepsis (13.33%), infective diseases (16.66%), tropical conditions (16.66%), medical disorders (26.66%) and hypertensive disorders (26.66%) were the major causes of admission to obstetric ICU. There were 33.3% mortalities observed in present study and 40% were due to respiratory failure. In ICU mechanical ventilation was done in 63.3% cases and blood products were given in 33.3% of patients.Conclusions: A multidisciplinary approach is ideal to handle non-haemorrhagic situations especially related to medical disorders and tropical diseases. Review of the ICU admissions and periodic audit can improve management of morbidities as well as reduce maternal mortalities.
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The long term success of periodontal therapy depends less on the manner in which the case was treated than on vigorous follow-up of the wound healing process immediately after therapy and on how well the case is maintained in subsequent recall (Rosling et al 1976, Nyman et al 1977, Knowles et al 1979, Ramfjord et al 1982, West felt et al 1985) SPT has gone by many names, including recall and maintenance, but the name was changed at the 1989 World Workshop in Clinical Periodontics to reflect the fact that the long-term treatment provided for patients during supportive periodontal treatment is of critical importance to the survival of the dentition. In most cases, this form of therapy is used following the completion of active periodontal therapy, but it can be used in other phases of treatment as well.1
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Introduction: Citrobacter infection occurs in a hospital setting in patients with multiple comorbidities and it occasionally causes disease in general population. Neonates and immunocompromised are highly susceptible to Citrobacter infections which are mainly caused by Citrobacter freundii and Citrobacter koseri, the incidence of nosocomial infections caused by antibioticresistant Gram-negative pathogens is increasing. This study was done to know the development of drug resistance in emerging pathogen Citrobacter. Methods: The study was conducted in the department of microbiology in a tertiary care hospital for a period of 1 year. Bacterial identification was performed by routine conventional microbial culture and biochemical tests using standard recommended techniques. The antimicrobial susceptibility testing was performed by the Kirby–Bauer disk diffusion technique on Mueller‑Hinton agar, as per the Clinical and Laboratory Standards Institute guidelines. Results: In the present study, 1788 pus samples were processed for a period of 1 year, out of which in 808 pus samples, organisms were isolated. Staphylococcus aureus was isolated in 234 (28.96%) cases. Escherichia coli was isolated in 168 (20.79%) cases, Pseudomonas was isolated in 125 (15.47%) cases, and Proteus was isolated in 32 (3.96%) cases. Enterobacter spp. was isolated in 51 (6.31%) cases. Acinetobacter was isolated in 16 (1.98%) cases. Candida spp. was 17 (2.10%). Citrobacter spp. was isolated in 85 (10.52%) cases. In 85 cases of Citrobacter spp., 58 (68.23%) were C. freundii and 27 (31.76%) were C. koseri. In the present study, Citrobacter spp. was sensitive to amikacin in 36.47% of cases, gentamycin in 48.88% of cases, and levofloxacin in 29.41% of cases. Conclusion: Citrobacter species is an emerging pathogen developing drug resistance. Drug options are limited in the current scenario; hence, injudicious and inadequate use of antibiotics should be avoided.
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Introduction: Breast carcinoma is the leading cause ofcancer mortality among females. Estrogen and Progesteronereceptors (ER, PR) and HER2 have been used for theranosticsin breast cancer. Fine needle aspiration cytology (FNAC)can yield highly cellular material for cytological diagnosis.Predictive biomarker assessment can be done on cytologicspecimens to know the patient’s eligibility for endocrinetherapy and anti- HER2- targeted therapy. Cell blocks furthercan increase the diagnostic accuracy through morphology andthe use of immunohistochemistry (IHC). The present studywas undertaken to evaluate immunohistochemical expressionof estrogen receptor, progesterone receptor and HER2 in fineneedle aspiration cell blocks and surgical biopsies in primarybreast carcinoma cases.Material and methods: IHC for ER, PR and HER2 wasassessed on 50 pre chemotherapy breast carcinoma cell blocks(fixed in 10% formalin) and subsequent tissue sections.The scoring for ER/ PR was done according to ASCO/CAPguidelines. Strong circumferential membrane staining ingreater than 10% of tumor cells was considered positive forHER2.Results: Immunostaining assessment on cell block and theircorresponding tumor tissues showed a good concordance: ER(92%), PR (92%) and HER2 (93.75%). Taking histology asthe final outcome, the sensitivity of ER, PR and HER2 on cellblock was 92.30%, 86.36% and 91.67%, respectively, whilespecificity was 92.85%, 96.43% and 94.44%, respectively.Conclusion: IHC on cell blocks from breast carcinoma casesis useful especially when planning neoadjuvant chemotherapy.The pre analytic and analytic variables should be validated tooptimize the diagnostic utility of cell blocks.
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Background: Peak Expiratory Flow (PEF) is a value test for lung function and can be conveniently measured by using relatively inexpensive and portable Peak Flow Meter, identifying and assessing the degree of airflow limitation of individuals. While PEFR is obviously related to factors like age, weight, height, race, gender, it may also be additionally affected by seasons and climate. The purpose of study being to observe seasonal variation in PEFR amongst school going children and to observe peak expiratory flow rate in school going children in urban and rural areas.Methods: This prospective and comparative study was carried out on total 600 children; with 300 each from rural and urban schools, of age group 10-14 years, both sexes. Peak expiratory flow meter was used for the measurements in the seasons of summer (April to June) and winter (December to February) of the year. The results thus obtained were compiled and analysed.Results: The mean PEFR value (Litres/min) during summers in the rural children was 243.50(S.D.=16.050) while during winters was 253.63(S.D.=16.934), highly significant (p<0.001); mean PEFR summers in the urban children was 241.50(S.D.=20.530)and during winters was 249.93(S.D.=21.685), again highly significant (p<0.001).In both rural and urban groups PEFR values increased with increase in height and weight of the children which was found to be highly significant (p<0.001). Girls representation proportion in rural vs urban schools being 49% vs 45%; whereas boys being 51% vs 55% respectively.Conclusions: Peak expiratory flow rate decreased during summer season of the year in both rural and urban school attending children. In both the groups PEFR values had a direct correlation with height and weight of the children. Rural schools showed more girl student representation than their urban counterparts indicating more awareness for girl child education amongst rural population.
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Background/Aims@#Optimal small bowel (SB) preparation for video capsule endoscopy (VCE) is controversial. Our study aimed to support the use of a specified volume of 4 liters of clear liquids for bowel preparation for VCE. @*Methods@#A retrospective review of 284 patients who underwent SB preparation with 2 liters of polyethylene glycol (PEG) and 284 patients who had 4 liters of clear liquid preparation. We analyzed image quality, endoscopic findings, completion rate, and transit times. @*Results@#The 4-liter clear liquid group had significantly higher mean image quality scores when compared to the PEG group (2.908±0.77 to 2.669±0.64, p<0.0001), as well as more studies with adequate preparation (72% to 64%, p=0.0214). Although the PEG group had more endoscopic findings on VCE (40% to 23%, p<0.0001), there was a significant difference in the indications for the procedure between the groups. There was no difference in the capsule completion rate or SB transit time. @*Conclusions@#Our data demonstrate significantly higher mean image quality scores when using a specified volume of 4 liters of clear liquid compared to 2 liters of PEG. This study supports the growing evidence of the effectiveness of a 4-liter clear liquid SB preparation as opposed to PEG for VCE.
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Background@#Bovine papilloma is a neoplastic disease caused by bovine papillomaviruses (BPVs), which were recently divided into 5 genera and at least 24 genotypes. @*Objectives@#The complete genome sequence of BPV type 15 (BPV Aks-02), a novel putative BPV type from skin samples from infected cows in Southern Xinjiang China, was determined by collecting warty lesions, followed by DNA extraction and amplicon sequencing. @*Methods@#DNA was analyzed initially by polymerase chain reaction (PCR) using the degenerate primers FAP59 and FAP64. The complete genome sequences of the BPV Aks-02 were amplified by PCR using the amplification primers and sequencing primers. Sequence analysis and phylogenetic analysis were performed using bio-informatic software. @*Results@#The nucleotide sequence of the L1 open reading frame (ORF) of BPV Aks-02 was 75% identity to the L1 ORF of BPV-9 reference strain from GenBank. The complete genome consisted of 7,189 base pairs (G + C content of 42.50%) that encoded 5 early (E8, E7, E1, E2, and E4) and 2 late (L1 and L2) genes. The E7 protein contained a consensus CX2CX29CX 2 C zinc-binding domain and a LxCxE motif. Among the different members of this group, the percentages of the complete genome and ORFs (including 5 early and 2 late ORFs) sequence identity of BPV Aks-02 were closer to the genus Xipapillomavirus 1 of the Xipapillomavirus genus.Phylogenetic analysis and sequence similarities based on the L1 ORF of BPV Aks-02 revealed the same cluster. @*Conclusions@#The results suggest that BPV type (BPV Aks-02) clustered with members of the Xipapillomavirus genus as BPV 15 and were closely related to Xipapillomavirus 1.
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Background/Aims@#Optimal small bowel (SB) preparation for video capsule endoscopy (VCE) is controversial. Our study aimed to support the use of a specified volume of 4 liters of clear liquids for bowel preparation for VCE. @*Methods@#A retrospective review of 284 patients who underwent SB preparation with 2 liters of polyethylene glycol (PEG) and 284 patients who had 4 liters of clear liquid preparation. We analyzed image quality, endoscopic findings, completion rate, and transit times. @*Results@#The 4-liter clear liquid group had significantly higher mean image quality scores when compared to the PEG group (2.908±0.77 to 2.669±0.64, p<0.0001), as well as more studies with adequate preparation (72% to 64%, p=0.0214). Although the PEG group had more endoscopic findings on VCE (40% to 23%, p<0.0001), there was a significant difference in the indications for the procedure between the groups. There was no difference in the capsule completion rate or SB transit time. @*Conclusions@#Our data demonstrate significantly higher mean image quality scores when using a specified volume of 4 liters of clear liquid compared to 2 liters of PEG. This study supports the growing evidence of the effectiveness of a 4-liter clear liquid SB preparation as opposed to PEG for VCE.
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Background: The aim of the study was to study the clinical profile of patients presenting with adverse drug reaction.Methods: The study was conducted in the Department of Medicine, IGMC Shimla from 01 July 2015 to 30 June 2016. A total of 129 patients were included in this study. A detailed history was taken followed by examination of patients. The routine investigations were done and special investigations as per need. For analysis patients detail, suspected drugs and the adverse drug reactions caused by them were used.Results: Bleeding from various sites was the most common event (39.5%), followed by symptomatic hypoglycemia 22.5% of events and symptomatic hyponatremia in 16.3% events. Amongst various drug classes anticoagulants were the most commonly involved drug class followed by oral hypoglycaemic agents, diuretics and antiplatelets. Type A was predominant ADR constituting (97.7%) of total ADRs and only (2.3%) of ADRs were of type B. After causality assessment, majority 86 (66.6%) were probable related and large number 127 (98.3%) of ADRs were serious which recovered after hospitalization.Conclusions: Our study revealed that ADRs are frequent and are easily recognized in clinical practice and are mostly preventable. Most ADRs are due to the use of drugs with high toxicity for example, warfarin often results in bleeding. It also shows that careful drug monitoring in hospitals may lead to reduction of many such ADRs, suggesting that some type A, ADRs may be due to inadequate monitoring of therapies and doses. This study will aid the development of interventions to reduce the impact of ADRs in hospital in-patients.
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Background: Hypertension is a very big global burden of disease with high incidence of morbidity and mortality (cardiovascular, stroke, renal and retinopathy) making it a leading cause of death all over the world. It is multifactorial in etiology and is difficult to manage at later stages once systemic organ damage has set in. But early detection can prevent this disease and intervention, if needed, can prevent morbidity and mortality in large number of patients. This study was done to find out the prevalence of hypertension in our area, in North India.Methods: A cross-sectional study was conducted in 1023 patients (including their attendants and staff) attending dermatology outpatient department of Maharaja Agrasen Medical College (MAMC), Agroha, Haryana, representing population from North India. Both urban and rural population was included with age 20 years and above.Results: The prevalence of hypertension in age group above 20 years was 31.1% (37.7% males and 22.6% females). The prevalence in age group above 30 years was 46% (54.4% males and 35% females), which showed a rising trend with age.Conclusion: High prevalence of hypertension was found in this study which increased with increasing age. We infer that more epidemiological studies should be done in India to detect hypertension at early stage which can help in preventing or early intervention in the treatment of hypertension and help in policy formulation at national level.
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Introduction: Primary fallopian tube carcinoma is a rare tumour accounting to almost 0.1-1.8% of all genital malignancies and difficult to diagnose preoperatively, because of its non-specific presentation as well as simulation with ovarian carcinoma. It is usually an intraoperative finding or a histopathological diagnosis. Case Report:The study present a case of 48 yr old post menopausal women who underwent abdominal hysterectomy with unilateral salpingo-oopherectomy for hydrosalpinx and ovarian cyst. Histopathological examination revealed, primary serous papillary adenocarcinom of fallopian tube. Conclusion: Primary tubal cancer is rare, mostly mistaken for ovarian carcinoma. Histopathological examination is the gold standard for final diagnosis