Vulvar melanoma with multisystemic metastases: A rare case presentation

Malignant melanoma is the second most common vulvar malignancy which occurs in elderly females. In advanced stages of the disease, distant metastases can occur to any organ; hence, comprehensive radiological evaluation is necessary. We report a case of a 45-year-old female who presented with progressively increasing growth over the vulva for 6 months. On detailed clinical, pathological, and radiological workup, multiple metastases were found in the brain, liver, pancreas, peritoneum, lungs, and pleura. The final diagnosis of vulvar melanoma with multisystemic metastases was made after the histopathological examination

Minimally-Invasive Plate Osteosynthesis for Clavicle Fractures / Osteossíntese minimamente invasiva com placa para fraturas de clavícula

Abstract Objective To analyze the radiological, clinical, and functional outcomes of clavicle fractures treated with the minimally-invasive plate osteosynthesis (MIPO) technique. Methods From June 2018 to July 2019, 17 cases of clavicular fractures were managed using the MIPO technique under C-arm fluoroscopy. The functional outcomes were assessed using the Constant-Murley score and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The clinical results of union, the complications, the operative time, the hospital stay, as well as infection, were analyzed. Results The mean follow-up time was of 10.41 1.75 months (range: 8 to 14 months). There were 11 male and 6 female patients, with a mean age of 39.05 10.76 years (range: 22 to 57 years). All fractures united on the mean time of 15.35 3.08 weeks (range: 12 to 20 weeks). The mean operative time was of 98.11 13.83 minutes (range: 70 to 130 minutes), and the mean length of the hospital stay was of 4.7 1.12 days (range: 3 to 7 days). The mean Constant-Murley score was of 74.82 6.36 in 4th postoperstive month, and of 92.35 5.48 in the 8th postoperative month, which was statistically significant. The mean DASH score was of 9.94 1.55 in the 4th postoperative month, and of 5.29 1.85 in the 8th postoperative month, which was also statistically significant. One patient had superficial skin infection at the site of the incision. Conclusions The MIPO technique is an alternative method for the fixation of clavicle fractures, but it is technically more demanding, and requires well-equipped operating room facilities.

Resumo Objetivo Analisar o resultado radiológico, clínico e funcional das fraturas da clavícula, tratadas pela técnica de osteossíntese com placa minimamente invasiva (MIPO). Métodos De junho de 2018 a julho de 2019, um total de 17 casos de fraturas claviculares foram tratadas com a técnica de osteossíntese com placa minimamente invasiva (MIPO), sob fluoroscopia com o braço em C. Os resultados funcionais foram avaliados por meio do escore de Constant-Murley e pelo escore de incapacidade do braço, ombro e mão (DASH). Foram analisados os resultados clínicos de consolidação, complicações, tempo cirúrgico, permanência hospitalar e infecção. Resultados O tempo médio de acompanhamento neste estudo foi de 10,41 1,75 meses (variação, 8 a 14 meses). Havia 11 pacientes do sexo masculino e seis do feminino, com média de idade de 39,05 10,76 anos (variação de 22 a 57 anos). Todas as fraturas se consolidaram no tempo médio de 15,35 3,08 semanas (variação, 12 a 20 semanas). O tempo cirúrgico médio foi de 98,11 13,83 minutos (variação, 70 a 130), sendo a permanência hospitalar média de 4,7 1,12 dias (variação de 3 a 7). O escore de Constant-Murley médio foi de 74,82 6,36 no 4° mês e 92,35 5,48 no 8° mês do pós-operatório, o que foi estatisticamente significativo. O escore DASH médio foi de 9,94 1,55 no 4° mês e 5,29 1,85 na 8ª semana do pós-operatório, também sendo estatisticamente significativo. Um paciente apresentou infecção cutânea superficial no local da incisão. Conclusões A técnica MIPO é um método alternativo para a fixação de fraturas da clavícula, porém é tecnicamente mais desafiador, já que necessita de instalações cirúrgicas mais bem equipadas.

Isolation and Characterization of Alkaline Pectinase Productive Bacillus tropicus from Fruit and Vegetable Waste Dump Soil

Abstract Alkaline pectinase is the utmost significant industrial enzyme of the bioscouring process. By considering bio scouring of cotton, 30 microbial isolates from fruit and vegetable waste rich dump soil of Solang Valley and Vasishta (Manali, Himachal Pradesh, India) were isolated and screened for the alkaline pectinase production in the current research work. Only four isolates P3, P16, P21, and P27 were capable to produce extracellular alkaline pectinase at pH 9. Further by applying submerged fermentation, the alkaline pectinase production was quantitatively screened. The most efficient isolate was P3 identified as Bacillus tropicus, based on morphological, biochemical, and molecular characterization. Molecular characteristics confirmed by 16S rDNA sequence analysis. The nucleotide sequence of the isolate was novel with a 97% similarity index and submitted to the GenBank with accession number MK332379. The Bacillus strain selected was active at broad pH range from 8-10.5 and a temperature range from 25-50 oC. Optimum pH and temperature observed were 9 and 37 oC respectively and can be suitably used for the bio scouring process for the pretreatment of the fabrics.

Incidence of culture proven neonatal sepsis, pattern of antibiotic sensitivity and clinical course in neonatal intensive care unit in tertiary care center in North India

Background: Neonatal sepsis is a major cause of neonatal mortality, accounts for nearly half of all the neonatal deaths in our country. The incidence of neonatal septicemia ranges from 1 to 10 per 1000 live births. In our country the incidence of culture proven neonatal sepsis is 8.6 per 1000 live births, intramural data. Antibiotics are rapidly losing their effectiveness, with some early reports going so far to suggest that we are approaching a post-antibiotic era. Aims of this study was to find out the incidence of culture proven neonatal sepsis and to analyze data collected for mortality and morbidity in culture proven neonatal sepsis and antibiotic sensitivity pattern in culture proven neonatal sepsis at Neonatal Intensive Care Unit of Santokba Durlabhji Memorial Hospital (SDMH), Jaipur.Methods: The study included 129 newborn fulfilling the inclusion criteria, admitted into NICU of SDMH, Jaipur from 01st January 2013 to 31st December 2013, were investigated using various hematological and biochemical test e.g. CBC, Serum CRP, Blood culture and sensitivity, CSF examination includes cell counts, gram staining, biochemistry, culture and sensitivity etc.Results: Overall 722 cases admitted in NICU during the period of one-year 2013. Out of which 129 cases had blood culture proven neonatal sepsis (17.87%). 14.88% cases in P.C.U. and 21.79% cases in I.P.U. had positive blood culture sepsis with statistically significant difference (p value 0.016, <0.05).Conclusions: Antibiotic resistance is an emerging problem requires justified use of antibiotics.

Synthesis of Some Novel Tetra Aryl Imidazoles Compounds: Evaluation of In-Vitro Cytotoxicity and Anthelmintic Activity

The imidazole derivatives have potent therapeutic activity against cytotoxicity and parasites. The present study was planned to synthesize novel tetra aryl imidazoles compounds and evaluated for in vitro cytotoxicity and anthelmintic activity. Firstly, 2-amine-4-chloro pyridine was condensed with substituted benzaldehyde to give corresponding Schiff’s base. These Schiff’s bases further on treatment with ammonium acetic acid derivation and isatin yielded comparing novel tetra aryl imidazoles. The synthesized compounds were examined for in-vitro cytotoxicity and anthelmintic activity. The discoveries showed that all the synthesized novel substituted imidazoles have moderate to great anthelmintic action. They additionally had critical in-vitro cytotoxicity against HEp2 cell lines (Human larynx malignancy cell line) against standard utilizing 5-fluorouracil. The compounds 1b, 2b, 4b, 6b, and 8b had higher anthelmintic action contrasted with standard mebendazole. The synthesized compounds 1b, 2b and 8b had noteworthy in-vitro cytotoxicity against HEp2 cell lines.

A Hospital Based Retrospective Study of Post Kala-Azar Dermal Leishmaniasis (PKDL) Cases

Post Kala-azar dermal leishmaniasis (PKDL) is a cutaneous form of leishmaniasis and usually occurs one to several years after apparent cure of visceral leishmaniasis (VL). Methods: The present work was designed as a retrospective tertiary urban hospital based, observational, clinico-epidemiological study during the period from February 2018 to January 2019. Results: A total of 24 PKDL patients, 16 males (66.66%) and 8 females (33.34%) were included in the study. The age of the patients ranged from 8 years to 56 years (mean age 30.6 years). Lesions in most of our patients (n=21, 87.50%) were located on the face, including the lip and nose. Most of our patients (n=20, 83.33%) were nodular (non-ulcerative), while two (08.33%) had nodulo ulcerative lesions and one (04.16%) had macular lesions. In the present study, 91.66.47 % (n = 22) of PKDL patients reported history of VL. The median time of manifestation of PKDL after VL treatment were 32 months (range = 5–286 months). Majority (n=20) of cases with history of VL had been treated with amphotericin B while the remaining (n=4,) had been treated with sodium stibogluconate. Conclusion: The present study highlights occurrence of PKDL in endemic area.Further epidemiological studies are required for identification of vector and strain of Leishmania involved.

Increasing number of secondary dengue cases: a concern

ackground: Dengue fever is caused by mosquito borne arbovirus of family Flaviviridae, Aedes agypti as the principle vector. In the recent past Delhi has witnessed several outbreaks affecting thousands of individuals and many of them get re-infected during subsequent years forming a bulk of secondary dengue cases putting them at risk of developing severe dengue.Methods: A total of 150 serum samples from suspected dengue cases were tested for dengue fever by NS-1 antigen and IgM antibody enzyme-linked immunosorbent assay (ELISA) followed by categorization into primary and secondary dengue using IgG avidity ELISA.Results: Out of total 150 clinically suspected dengue cases, 56 were positive either by Dengue NS-1 antigen or dengue IgM antibody or both. On the basis of dengue IgG avidity ELISA among 56 diagnosed dengue cases, 30 (53.57%) were found to be of secondary dengue.Conclusions: There is increasing trend of dengue cases in Delhi since past one decade. Being hyper-endemic area for dengue, more than 25% population have been reported to have past infection of dengue. Due to increased prevalence and simultaneous circulation of more than one serotypes, number of secondary dengue cases is also increasing. Since majority of severe dengue cases are associated with secondary dengue, early diagnosis and treatment can significantly reduce the fatal outcome. Thus, avidity testing for IgG antibody becomes an important tool.

Comparison Of Upper Lip Bite Test And Modified Mallampati Classification In Predicting Difficult Intubation

Introduction : Airway management is of prime importance to the Anaesthesiologist for securing the airway, tracheal intubation using direct laryngoscopy remains the method of choice in many cases. Difficult laryngoscopic endotracheal intubation still remains an important concern of anaesthesiologists. The incidence of difficult endotracheal intubation were reported to be between 1.5% to 13% among patients undergoing surgery. The present study was conducted with the primary aim to evaluate sensitivity, specificity, accuracy, negative predictive value and positive predictive value of Upper Lip Bite Test and Modified Mallampati Classification to predict difficult intubation in patients undergoing any elective surgery under general anesthesia. Material & Methods : A single-blind, Prospective Observational (Analytical) study was conducted in Krishna Institute of Medical Sciences, Hospital and Research Centre, Karad, Maharashtra after the approval from the institutional ethical committee. Asample size of 181 patients of both gender, between 20 and 50 years of age, belonging to ASAphysical Status I-II scheduled to undergo elective surgery under general anaesthesia with endotracheal intubation were evaluated for both test before surgery after fulfilling the inclusion criteria. A senior Anaesthesiologists having minimum five years of experience in clinical anaesthesia who unaware of preoperative airway assessment, performed laryngoscopy and grading as per Cormack and Lehane's classification. Senstivity, specificity,accuracy, positive and negative predictive values of Upper lip bite test and Modified Mallampati Classification were calculated. Results:We compared various accuracy parameters of both the methods (MMTand ULBT), we observed that MMT(88.23% Vs. 76.47%) has got higher sensitivity, higher specificity of (89.02% Vs. 87.19%), higher positive predictive value (45.45% Vs. 38.23%) and higher negative predictive value (98.64% Vs. 97.27%) as compared to ULBT. Conclusion : In comparison with ULBT, MMT has got better predictive ability for difficult endotracheal intubation. MMT and ULBT appear to be better predictors for easy intubations rather than difficult intubations (high negative predictive value). Combination of MMT and ULBT has got better diagnostic accuracy as compared to MMTor ULBTalone.

Human Trafficking: New Challenge to Humanity

This paper addresses the situation of human trafficking inIndia. It argues that the focus on trafficking either as an issueof illegal migration or prostitution still dominates the discourseof trafficking, which prioritizes state security over humansecurity and does not adequately address the root causes oftrafficking and the insecurity of trafficked individuals. The rootcauses or vulnerability factors of trafficking such as structuralinequality, culturally sanctioned practices, poverty or economicinsecurity, organ trade, bonded labor, gender violence, whichare further exacerbated by corruption, have remainedunrecognized in academic and policy areas. This paper arguesthat emphasis needs to be given to such underlying rootcauses and modes and also crimes related to humantrafficking, that threatens human security of the traffickedpersons in India. Accordingly, it provides some preventivemeasures to address and deal with the problem.

Prevalence of human papillomavirus infection & cervical abnormalities in HIV-positive women in eastern India.

Background & objectives: India has the third highest burden of HIV and highest number of cervical cancer in the world. A cross-sectional study was performed to determine the prevalence and types of human papillomavirus (HPV) infection, and the factors associated with HPV infection and abnormal cervical cytology in HIV-positive women attending the Antiretroviral Therapy (ART) Centre in a tertiary care hospital in eastern India. Methods: We screened 216 HIV- positive women with Papanicolau smear cytology and HPV testing. HPV DNA was detected by using consensus primers followed by sequencing. Results: Of the 216 HIV-positive women screened, 58 (26.85%) were HPV-positive; 56 (25.9%) were of high-risk (HR) HPV type. The most prevalent HPV type was HPV-16 (7.9%); non 16 and 18 HPV types were present in 17.6 per cent patients. Age ≤ 35 yr [(OR), 2.56 (1.26-5.19)], illiteracy [OR, 2.30 (1.19-4.46)], rural residence [OR, 3.99 (1.27-12.56)] and CD4 ≤350/μl [OR, 2.46 (1.26-4.83)] were associated with increased risk of acquisition of HPV. One hundred thirty nine (74.33%) patients had normal/ negative for intraepithelial lesions (NILM) cytology, three (1.60%) had atypical squamous cells of undetermined significance (ASCUS), 32 (17.11%) had low-grade squamous intraepithelial lesions (LSIL), 10 (5.35%) had high-grade squamous intraepithelial lesions (HSIL) and three (1.60%) had carcinoma cervix. WHO clinical Stage III and IV [OR, 2.83 (1.07-7.49)] and CD4 ≤350/μl [OR, 2.84 (1.30-6.20)] were risk factors for abnormal cytology. Interpretation &conclusions: Our study showed 26.85 per cent HPV positivity in HIV infected women in this region, with HPV-16 as the commonest genotype. Abnormal cervical cytology was seen in about 25 per cent women. Regular Pap smear screening as recommended by the National AIDS Control Organization will help in early detection of cervical abnormalities in HIV- positive women.

Hypercalcemia as Initial Presentation of Metastatic Adenocarcinoma of Gastric Origin: A Case Report and Review of the Literature

Hypercalcemia of malignancy due to metastatic gastric adenocarcinoma is extremely rare; in fact, to the best of our knowledge, only three case reports of hypercalcemia associated with metastatic gastric adenocarcinoma have been published in the literature to date. Herein, we report a rare case involving a 61-year-old African-American female who had hypercalcemia at initial presentation and who was later diagnosed with poorly differentiated gastric adenocarcinoma with extensive liver metastases, without bone involvement. She was found to have elevated parathyroid hormone-related peptide and normal parathyroid hormone levels. Despite aggressive treatment, she died within a few months of diagnosis.

Intraosseous Calcaneal Lipoma with Subtalar Perforation through Cystic Degeneration: A Case Report / 대한족부족관절학회지

Intraosseous lipoma is a benign tumor that originates from proliferating mature lipocytes. It often occurs in the metaphysis of long bones of the lower extremity, and also in the calcaneus, humerus, mandible, sacrum, and rib bones. Frequently, it involutes spontaneously through a process of infarction, calcification, and cyst formation. It can either present as pain, or be asymptomatic and only discovered through an incidental radiological finding. In our case, the patient presented with heel pain. Intraoperatively, it was found that the intraosseous cavity was filled with fat along with an adjacent but separate area of cystic degeneration. There was also a cortical perforation at the cystic lesion which was communicating with the subtalar joint. This cortical breach is most likely the cause of diffuse lateral heel pain experienced by our patient, and such a pathological fracture due to intraosseous lipoma has never been reported.

Isolated Talonavicular Arthrodesis as an Option for Severe Rocker Bottom Foot Deformity: A Case Report / 대한족부족관절학회지

We report on a case of post-burn contracture and right foot deformity in a 37-year-old female who underwent two surgical interventions at the age of seven years. The patient remained well without any associated problems until she presented to our hospital at the age of 37 years with severe pain and right foot deformity. A few treatment modalities have been reported, and amputation has been suggested as the best approach. However, our patient was treated with a talonavicular arthrodesis and a soft tissue procedure, which resulted in a stable, plantigrade, and pain-free foot with an unsupported, bipedal gait.

Factors associated with seeking treatment for postpartum morbidities in rural India / 한국역학회지

OBJECTIVES: To understand the prevalence of postpartum morbidities and factors associated with treatment-seeking behaviour among currently married women aged 15-49 residing in rural India. METHODS: We used data from the nationally representative District Level Household Survey from 2007-2008. Cross-tabulation was used to understand the differentials for the prevalence of postpartum morbidities and treatment-seeking behaviours across selected background characteristics. Two-level binary logistic regression was applied to understand the factors associated with treatment-seeking behaviour. RESULTS: Approximately 39.8% of rural women suffered from at least one of the six postpartum morbidities including high fever, lower abdominal pain, foul-smelling vaginal discharge, excessive bleeding, convulsions, and severe headache. Morbidities were more prevalent among poor, illiterate, Muslim, and high-parity women. About 55.1% of these rural women sought treatment/consultation for their problems. The odds of seeking treatment/consultation increased as economic status and years of schooling among both the woman and her husband increased. Poor, uneducated, unemployed, Hindu, and tribal women were less likely to seek treatment/consultation for postpartum morbidities than their counterparts were. The odds of seeking treatment/consultation decreased as the distance to the nearest private health facility increased. Most women visited a private hospital (46.3%) or a friend/family member's home (20.8%) for treatment/consultation. Only a small percentage visited publicly funded health institutions such as a primary health centre (8.8%), community health centre (6.5%), health sub-centre (2.8%), or district hospital (13.1%). Rural women from the northeast region of India were 50% less likely to seek treatment/consultation than women from the central region were. CONCLUSIONS: Providing antenatal and delivery care, and ensuring nearby government healthcare facilities are available to serve rural women might increase the likelihood of care-seeking for postpartum morbidities. Targeted interventions for vulnerable groups should be considered in future policies to increase the likelihood women will seek treatment or advice postpartum.

A cross-sectional prospective study of pleural effusion among cases of chronic kidney disease.

Background. Pleural effusions of diverse aetiologies are encountered in patients with chronic kidney disease (CKD). The objectives of the present study were to examine the frequency of occurrence, causes, clinical features and management strategies of pleural effusion in patients with CKD including renal transplant recipients. Methods. A prospective cross-sectional observational analysis of pleural effusion in adult patients with CKD (stages 3 to 5) attending the Departments of Nephrology and Respiratory Medicine of a tertiary care institution in Eastern India was performed over a period of one year (February 2010 to January 2011). Results. Pleural effusion was found in 29 out of 430 patients with CKD (6.7%) and in two out of 34 post-renal transplant recipients (5.9%) evaluated during the study period. The mean age was 37.35±1.8 (mean±SEM [standard error of mean]) with a male to female ratio of 2:1. Exudates and transudates were found in equal frequencies. Heart failure was the single most common cause (41.9%, 13 of 31). Tuberculosis (TB) (n=8, 25.8%) and uraemic effusions (n=6, 19.4%) were responsible for the majority of exudates. Unilateral effusion with a normal heart size had a positive predictive value of 83.3% for nonheart failure aetiology. Conclusions. Symptomatic pleural effusion was present in a small proportion of 6.7%; (n=29) patients with CKD including post-renal transplant recipients. Heart failure, TB and uraemic effusions accounted for most of the cases. Differentiating TB from uraemic effusion requires a combined clinico-pathological approach and this differentiation is absolutely necessary for proper management.

Acute Toxicity Of Euphorbia Royleana Boiss (Euphorbiaceae) latex on freshwater catfish, Heteropneustes Fossilis (Siluriformes, Heteropneustidae) / Toxicidad aguda del látex de Euphorbia royleana Boiss (Euphorbiaceae) en el bagre de agua dulce, Heteropneutes fossilis (Siluriformes, Heteropneustidae)

An acute toxicity test was performed by using a four-day static renewal test to determine the LC50 value of aqueous extract of Euphorbia royleana latex for the freshwater fsh, Heteropneustes fossilis. The LC50 values, their upper and lower confdence limits and slope functions were calculated. The LC50 values for aqueous extract of Euphorbia royleana latex at various exposure periods were 7.758 mg/L for 24 h, 5.847 mg/L for 48 h, 4.474 mg/L for 72 h and 3.090 mg/L for 96 h. The regression coeffcient showed that there was signifcant negative correlation between exposure time and different LC values. Hence, it is concluded that the concentration to produce toxicity of latex of Euphorbia royleana is comparable and close to the concentration to produce toxicity of synthetic organophosphates pesticides for the fsh H. fossilis. Therefore, adequate precautions must be taken when Euphorbia royleana latex is being used near fsh- inhabited areas.

La prueba de la toxicidad aguda fue realizada utilizando un test estático con renovación, de cuatro días de duración, para determinar el valor de la CL50 de un extracto acuoso del látex de Euphorbia royleana, en el pez de agua dulce Heteropneustes fossilis. Se calcularon el valor de la CL50, los límites de confanza máximo y mínimo y la pendiente. Los valores de la CL50 para el extracto acuoso del látex en varios períodos de exposición fueron 7,758 mg/L para 24 h, 5,847 mg/L para 48 h, 4,474 mg/L para 72 h y 3,090 mg/L para 96 h. El coefciente de regresión mostró una correlación negativa signifcativa entre el tiempo de exposición y diferentes valores de la CL50. Se concluye que la concentración del látex de E. royleana que produce toxicidad es comparable y cercana a la de los plaguicidas sintéticos organofosforados para el pez H. fossilis. Por lo tanto, se deben tomar precauciones adecuadas cuando el látex de E. royleana es utilizado cerca de áreas donde habita el pez H. fossilis.

Vibrational dynamics and heat capacity in polyglycine II.

The earlier works on the vibrational dynamics of polyglycine II (PG II) suffer from several infirmities, which not only suppress the dynamical nature of normal modes, but also lead to several incorrect assignments and interactive constants of the potential field. In this study, we have re-examined the phonon dispersion profiles of PG II using Higgs method for evaluation of phase-related normal modes and have attempted to remove the infirmities, as far as possible. The Wilson's GF matrix method combined with the Urey-Bradley force field has been used for normal mode analysis. This potential field leads to correct assignments of Raman, infrared and inelastic neutron scattering frequencies. Characteristic features of the dispersion curve (v versus delta/pi plot), such as repulsion and regions of high density-of-states have been interpreted. In addition, the heat capacity as a function of temperature has been obtained via density-of-states. It agrees well with the experimental data and is being reported for the first time.