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Duchenne muscular dystrophy is one of the most common dystrophinopathies known. It is the most common hereditary neuromuscular disorder and is inherited in an X-linked recessive manner. Incidence is 1:3500 live male infants, characterised by progressive weakness of a selective group of muscles without involvement of nervous system. Age of onset being 3-10 years, many children unable to walk before 18 months of age. The patient usually dies by 18-20 years of age. 80% carries have high CPK values with female being the one. Dystrophin gene is the largest human gene with 79 exons, codes for protein dystrophin required for stabilisation of protein complex at sarcolemma, the abnormal DMD gene is on X chromosome at Xp21 locus. Dystrophin deficiency thus, leads to destruction of muscle fibres and progressive muscular weakness. Corticosteroids are the only medications that have shown to alter the course of DMD but have side effects like weight gain, decreased appetite, increase changes of cataract and osteoporosis. The present study is about management 8 years old male child with B/L lower limb weakness and calf muscle hypertrophy.etc, so according to Ayurvedic management with Panchkarma procedures and internal medicines given the case was managed. Successful improvement in CPK values along with the signs and symptoms was observed. As per Ayurvedic Siddhant and Samprapti application considering Adibalapravrittavyadhi and the Beejabhaga avayava dushti the management done. There is no treatment in any system of medicine and prognosis being unpreventable, Ayurveda instills a regenerative mechanism in neuromuscular disorders with special concern of Panchkarma, Rasayanas, Rasa aushadhi, etc. By this the deterioration can effectively be prolonged and quality of life improved.
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Purpose: To assess the fluoroquinolone resistance pattern and trends among bacterial isolates from ocular infections over a 16?year period and explore alternative antibiotics in fluoroquinolone?resistant strains. Methods: In this retrospective, longitudinal study, the microbiology laboratory records of patients with different ocular infections diagnosed at an eye institute in central India from 2005–2020 were reviewed to determine the pattern of fluoroquinolone (ciprofloxacin, ofloxacin, gatifloxacin, and moxifloxacin) resistance. Antibiotic susceptibility testing was done using the Kirby–Bauer disc diffusion method. Results: In 725 Gram?positive bacteria, the resistance of ciprofloxacin, ofloxacin, gatifloxacin, and moxifloxacin was 55.9% (95% confidence interval [CI]: 52.2 – 59.6), 42.7% (95% CI: 39.0 – 46.4), 47.6% (95% CI: 43.9 – 51.3), and 45.6% (95% CI: 41.7–49.5), respectively. In 266 Gram?negative bacteria, the resistance of ciprofloxacin, ofloxacin, gatifloxacin, and moxifloxacin was 57.9% (95% CI: 51.9 – 63.9), 56.0% (95% CI: 49.7 – 62.1), 59.9% (95% CI: 53.8 – 66.0), and 74.3% (95% CI: 68.3 – 80.2), respectively. A declining trend in resistance to ciprofloxacin (P < 0.001), ofloxacin (P < 0.001), and moxifloxacin (P < 0.001) was seen in Gram?positive bacteria, whereas a reduction in resistance to only moxifloxacin (P = 0.04) was seen in Gram?negative bacteria. In fluoroquinolone?resistant Gram?positive bacteria, cefuroxime exhibited the highest susceptibility, whereas in fluoroquinolone?resistant Gram?negative bacteria, colistin exhibited the highest susceptibility. Conclusion: Fluoroquinolone resistance was high among bacteria from ocular infections in central India, but a declining trend in resistance to some of the fluoroquinolones was observed in recent times. Cefuroxime and colistin emerged as alternatives in fluoroquinolone?resistant Gram?positive and Gram?negative bacterial infections, respectively.
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Background: Pelvi-ureteric junction obstruction (PUJO) is defined as anatomical or functional obstruction to the flow of urine from the pelvis to the upper ureter. This may be unilateral or bilateral. Most of the hydronephrosis cases are due to Pyelo-ureteral junction obstruction (PUJO) which can be diagnosed antenatally. The treatment protocol for antenatal diagnosed PUJO is standardized. Few children present later in life. Present study was done to evaluate clinical profile and outcome of infants and children (<12years) presenting with PUJO. Methods: A retrospective observational study conducted by the department of Paediatric Surgery, SDM hospital Dharwad. All children with age less than 12 years with PUJO from March 2017 to March 2020 were included in the study (n=51). Initial evaluation was done with Ultrasound KUB (Kidney, Ureter, Bladder). A diuretic renogram/ EC (Ethylene cysteine) was done to confirm the diagnosis. The children were managed both conservatively and surgically (Pyeloplasty), depending on the presentation. The children were followed up post-surgery. Results: Fifty one patients were included in the study. Mean age of presentation was 31±30 months. Most common presentation was pain abdomen which was seen in 9 patients (17.6%). 6 patients (11.7%) presented with Lump and 2(4%) presented with fever. Left kidney was commonly involved (66%). Males predominate (80%). The mean antero-posterior pelvic dimension (APPD) of involved kidney was 30mm with range from 12.5mm to 68mm. 4 (7.8%) children presented with poorly functioning kidney with split renal function less than 10%. PUJO was associated with Pelvic calculi, VUR, Horseshoe kidney, Mal-rotated kidney. Out of the 51 patients, 9 (17.6%) were kept in conservative management 42 (82.3%) underwent Pyeloplasty. Among 42, 1 underwent redopyeloplasty and 1 underwent nephrectomy. In rest of the operated patients (Post-pyeloplasty) diuretic renogram showed improved drainage with improved function. Conclusions: PUJO is common cause of urinary obstruction in children. Earlier the diagnosis, better the outcome. Delay in diagnosis or presentation leads to increased chances of renal damage and loss. Hence it is important to diagnose PUJ obstruction at the earliest and receive prompt treatment.
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Background: Prostatic lesions are common among elderly men with urinary complaints. Variety of prostatic lesions range from inflammatory, benign to malignant pathologies. The Prostate specific antigen (PSA) is secreted by glandular epithelium of prostate shows raised serum levels in these pathologies. Usually significant rise is commonly associated with Prostatic adenocarcinomas (PCa) with exceptions.Methods: In this retrospective study, total 63 diagnosed cases of prostatic lesions over a one-year period for which serum PSA levels were available, were selected. Cases without serum PSA levels & inadequate biopsies were excluded. Histological diagnosis of prostatic lesions reconfirmed and its correlation with serum PSA was done.Results: Study included patients with mean age 67.84 years (range: 48-60) at the time of diagnosis. Benign lesions were commonest prostatic lesions accounting for total 54 cases (85.71%) out of which 38 were of Benign prostatic hyperplasia (BPH), 14 cases of BPH with prostatitis while single case each for BPH with granulomatous prostatitis and basal cell hyperplasia. Mean PSA value for benign lesions was 6.57 ng/ml. Total 8 were malignant which included 7 (11.11%) PCa while single (1.59%) case of metastatic transitional cell carcinoma. Mean PSA for PCa were 35.05 ng/ml. Single case (1.59%) of high grade prostatic intraepithelial neoplasia also detected.Conclusion: Common age group at the time of presentation of prostatic pathologies is 60-70 years. The most common prostatic lesions are benign predominantly BPH. PCa are commonest malignancies. Elevated PSA levels >20 ng/ml are commonly observed in PCa. However lower or normal values don’t rule out PCa.
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'Background: Teaching undergraduate students by bedside clinics has remained cornerstone of medical education because it imparts knowledge, teaches proper behaviour and can be used to teach skills effectively. Case based learning (CBL) is a newer modality of teaching in medical education. CBL involves preparing students for clinical practice through use of authentic clinical cases. 'Aim of the study is to study the effect of integration of case based learning and bed side clinic on motivation, deep thinking and cognitive improvement in final MBBS studentsMethods: The study group was undergraduate students of final MBBS posted for clinical posting in pediatric ward. The study was carried out on 59 students posted from March 2018 to September 2018. MCQ based pretest was done initially. The students were taught the topic by case based learning method for one hour. They were asked to take the case and bedside clinic was conducted. Relevant clinical examination was demonstrated to the students. Students were asked to practice the skills in front of the teacher. This was followed by the post-test and'' questionnaires.Results: 88.67% students thought that this method was motivating. 82.7 % students perceived that it increases deep thinking. 52.83% students showed more than 20% improvement in score of pre-test and post-test.Conclusions: Integration of case based learning with bed side clinic was associated with Better motivation of final year MBBS students and development of deep thinking in students.' 3. Significant change in cognitive learning in final MBBS students.
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Background: Accumulating evidence suggests that adiponectin, a major adipocyte secretory protein, has insulin-sensitizing and anti-atherogenic properties and protects against later development of type 2 diabetes. We investigated the association of adiponectin with insulin resistance, blood lipids and type 2 diabetes in non obese central Indian population.Methods: Anthropometric and biochemical parameters were measured in 149 (81 male and 68 female) newly diagnosed non obese type 2 diabetic patients and 157 (85 male and 72 female) age and body mass index (BMI) matched controls.Results: Adiponectin level (p<0.0001) was significantly lower in the diabetic group than in non diabetic control. In an age, gender and BMI adjusted model, adiponectin level was significantly negatively correlated with waist circumference, waist to hip ratio, systolic blood pressure, fasting insulin, homeostasis model assessment-insulin resistance (HOMA-IR) (p= 0.0034), HbA1C, total cholesterol, LDL-cholesterol, and triglycerides (p<0.0001) and positively correlated with HDL-cholesterol (p =0.0014) in non obese type 2 diabetic group. However, there was no significant correlation between adiponectin and glucose in this study. In stepwise linear regression analysis, adjusted for potential confounder, significant inverse association was observed between serum adiponectin level and HOMA-IR (p = 0.0001). In multivariate logistic regression model, adjusted for age, gender, BMI, waist circumference, and waist-hip ratio, lower adiponectin was independently associated with the presence of type 2 diabetes (p<0.0001).Conclusions: Lower adiponectin levels in non obese type 2 diabetic patients were significantly related to the increased insulin resistance, dyslipidemia, and presence of type 2 diabetes, independently of overall and abdominal adiposity, thereby suggesting a direct link between adiponectin and carbohydrate and lipid metabolism in human.
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Verrucous hyperplasia [VH] is a rare exophytic oral mucosal lesion which can transform into verrucous carcinoma [VC], its malignant but clinically similar counterpart. These entities can be distinguished by the lack of invasive growth in VH cases; as such, it is essential to include a margin with adequate depth when performing a biopsy of the epithelium of the lesion. We report an 80-year-old male patient who presented to the Bapuji Dental College and Hospital, Davangere, Karanataka, India, in 2011 with a warty whitish-pink growth on the inside of his cheek. The patient was treated with wide surgical excision of the lesion and a diagnosis of VH was made based on histopathological features. There was no evidence of recurrence at a five-year follow-up. This report highlights the histological variations, pathogenesis and differential diagnosis of VH
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Scedosporium prolificans have been reported to be resistant to all antifungals including the newer azoles and echinocandins. We report an unusual case of repeated S. prolificans infection of the heart valves in an immunocompetent patient.
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Endurance athletes require a very efficient oxygen transport system for maximal aerobic power during physical work performance. Many studies carried on endurance athletes suggested low levels of red blood cell markers leading to misconception of existence of so called sports anaemia in athletes. Sometimes athletes are on needless iron supplementation and are concern about anaemia. The main objectives of the study were to investigate the red cell population markers and to study the sports anaemia phenomenon in endurance athletes and the underlying responses responsible for ot. 60 male endurance track and field runners age group 18-21 were selected from the local city based club named Vasant Desai Krida Sangh Akola and were compared with the age, height sex matched non athletes students of Govt. Medical College Akola. The seven red blood cell markers were studied from the blood samples taken from the cubital vein under standard conditions. The blood variables for both the groups were analyzed with an automatic cell counter. The mean values of Hb(12.27 gm% +/- 0.782), RBC count in(3.64millions per cu mm+/-0.52), hematocrit ( 41.58 % +/- 1.32), mean corpuscular Hb conc (MCHC 29.49% +/- 1.198) were all very significantly lower ( p<0.0001) as compare to controls. Whereas the plasma volume (58.412% +/- 1.32), Mean Corpuscular volume (MCV 115.06 cu microns+/- 11.54)), Mean Hb conc (MCH 33.998 picogms+/- 2.608), were significantly increased in endurance athletes. Though decrease in Hb conc, Low RBC count and less hematocrit in endurance athletes indicate presence of anaemia in them but it’s not a true anaemia as it is also confirmed by MCV, MCH, MCHC values between the two groups. The significant differences between the groups are due to the response to endurance training leading to hemo dilutional anaemia caused by plasma volume expansion which increases the blood volume in endurance athletes helping them for better oxygen supply and aerobic power needed during physical work.
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Goldenhar syndrome or fascio-auriculo-vertebral dysplasia or oculo-auriculo-vertebral syndrome is a sporadic or autosomal dominant inherited genetic rare syndrome characterized by mandibular hypoplasia, facial asymmetry, low set ear or atresia of ear canal, preauricular skin tags, hemi vertebra in cervical region, epibulbar dermoid, coloboma of upper eyelid, limb dermoids, cardiac abnormalities and other systemic abnormalities includes facial involvement, predisposing to the right side or there may be a more complex phenotypic abnormality with the skeletal, cardiac, renal and pulmonary systems. Central nervous system involvement are common with these patients, particularly there are higher chances with ophthalmologic anomalies. 50% of the patients with Goldenhar would have either conductive and/or sensorineural hearing loss. This case report describes a typical 40-year-old female patient who presented to the hospital with auricular abnormality and diminished hearing and was found to have the fascioauriculo-vertebral dysplasia spectrum of this syndrome and hypothyroidism. Diagnosis was based principally on clinical aspects. Radiology, laboratory fi ndings, otorhinolaryngologic evaluations were important in reaching a defi nitive diagnosis. Management depends on the patient’s age and systemic clinical manifestations, with a multidisciplinary approach often being required.
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The occurrence of bilateral extradural hematomas is an uncommon consequence of cranio-cerebral trauma. In the literature bilateral, extradural hematomas have rarely been reported. This article is about a case of 45-year-old female who was admitted in our hospital with a history of road traffi c accident. On admission, she was conscious but irritable having Glasgow coma scale 14/15. In stable condition, she was found to have visual agnosia for left eye. Her computed tomography scan showed a bilateral symmetrical site with asymmetrical dimensions. Patient underwent left occipito-posterio-parietal craniotomy with complete removal of extradural hematoma was done. Right occipital extradural hematoma was not removed.
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Background & objectives: There is great public and scientific interest in the status of exercise and physical fitness among the preadolescent and adults. The physical activities should increase to intervene health problems since it emphasizes wellness and promotes self-awareness. Heart is the only organ facing overload of the regular physical exercise. The structure of athletes' heart or physiological variations associated with training leading to left ventricular hypertrophy has been referred as Athlete’s Heart syndrome. Methods: To evaluate the prevalence and importance of "physiological" left ventricular hypertrophy (LVH) in athletes, the electrocardiographic and echo-cardio graphic parameters of 40 track and field runners were studied. Results: Electrocardiographic evidence of resting bradycardia, LVH, present in athletes, was associated with concomitant echo-cardio graphic evidence of a thickened left ventricular (LV) posterior wall, with an enlarged end-diastolic LV diameter. Cardiac hypertrophy and dilatation commonly develop in well-conditioned athletes. Interpretation & conclusion: Enlargement (increase in diameter by echocardiography) in the left ventricular cavity associated with physiological LVH characterized by increased voltage in ECG & posterior wall and IVS by echo-cardio graphic thickness play important role in maintaining optimal cardiac performance during training as well as competition and normal cardiac performance at rest.
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This study attempted to determine noninvasively whether a dysregulation of autonomic reflexes exists in children with breath holding spells (BHS).Fifty children between 13 to 47 months of age who had experienced BHS were evaluated at a time when they stopped having spells, for autonomic nervous system (ANS) dysfunction. The results were compared with the test results of control group of 100 normal children (age and sex matched). Breath holding children displayed significantly high resting heart rate and resting diastolic BP significantly abnormal; 30: 15 RR ratio after rising from supine to standing position; showed significant hypersensitivity of pupil on instillation of 0.125 percent pilocarpine into conjunctival sac and positive Orthostatic signs when compared to control group. This study correlates with the hypothesis that a subtle underlying generalized autonomic dysfunction exists in children with BHS.