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ABSTRACT Objective: Data regarding rare FPAs from India, a resource limited setting, are limited. We describe a case series of rare FPAs from a single center in western India. Materials and methods: This was a retrospective case record review of patients diagnosed between January 2010 and July 2022. The diagnosis was based on biochemical (inappropriately elevated serum FSH/LH) and pathologic (positive immunostaining for FSH/LH) features in patients with FGA, and elevated serum thyroid hormones and normal/elevated TSH in patients with TSHomas. Results: We identified 11 patients with a total of six FGAs (median age 43.5 years, five men, one FGA cosecreting TSH, median largest dimension 40 mm, range 33-60 mm) and six TSHomas (median age 34.5 years, four women, two TSHomas cosecreting GH, median largest dimension 42.5 mm, range 13-60 mm). Symptoms of sellar mass effects led to pituitary imaging in most patients with FGA. Patients with TSHomas had symptoms of excess hormone secretion (GH/TSH) or sellar mass effects. The TSHomas that cosecreted GH/FSH were larger than those secreting only TSH. Transsphenoidal resection was the most common first-line therapy but significant residual disease was frequent (3 out of 6 FGAs and 4 out of 5 TSHomas). Conclusion: This is the first and second case series of FGAs and TSHomas, respectively, from India. In this study, TSHomas presented at younger age, were larger and had low surgical cure rates.
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The future of sustainable energy is bright, with continued advancements in technology and growing global awareness of the need to transition to renewable energy sources to combat future challenges. The electrical vehicle is new hope for the automobile industry where the deduction of carbon emission is the priority. The increasing level of carbon emission may be harmful to the environment and society. A qualitative exploration of sustainable energy and its role in electrical vehicles are other aspects of the study where green energy is another variable. The research design used in the study is exploratory in nature and covers the different dimensions of sustainable energy. Production of the batteries is also following certain protocols of natural sustainability and emission. This study will enunciate the role of sustainable energy sources under the aspects of green energy. Economic benets are also associated with the dened issue. Resultants are qualitative in nature where the crux of the previous study had been discussed. This study has concluded
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Objective: To describe the characteristics of gonadotropin-dependent precocious puberty (GDPP) in Indian children. Methods: Clinical profiles of GDPP (n=78, 61 females) and premature thelarche (n=12) from a single center in Western India were retrospectively studied. Results: Pubertal onset was earlier in boys than girls (29 vs 75 months, respectively; P=0.008). The basal luteinizing hormone (LH) was ?0.3 mIU/mL, except 18% of GDPP girls. At 60 minutes after GnRHa-stimulation, all patients (except one girl) had LH ?5 mIU/mL. The GnRHa-stimulated LH/FSH ratio was ?0.34 at 60 minutes in girls with GDPP unlike premature thelarche. Only one girl had an allergic reaction to long-acting GnRH agonist. Among GnRH agonist-treated girls (n=24), the predicted final adult height was -1.67±1.5 SDS, whereas the attained final height was -0.25±1.48 SDS. Conclusion: We establish the safety and efficacy of long acting GnRH agonist therapy in Indian children with GDPP. The 60-minute stimulated serum LH/FSH of ?0.34 differentiated GDPP from premature thelarche.
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Introduction:Cardiac venous system is an important system for various cardiac interventional procedures such as cardiac catheterization. Various veins like right marginal vein, small cardiac vein (SCV), posterior vein of the left ventricle, left marginal vein, oblique vein of Marshall drain into coronary sinus. While anterior cardiac veins drain right ventricular wall directly into right atrium. Materials and Methods: An observational cross‑sectional study was conducted on thirty cadaveric hearts during a 2‑year period in Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Anatomy Department. The length, diameter of SCV, left marginal vein, posterior vein of the left ventricle, right marginal vein, and oblique vein of Marshall were taken. Results: The study reveals the length of SCV as 28.12 ± 22.87 mm. The length of right marginal vein and posterior vein of the left ventricle is having a significant correlation with age. The length of oblique vein of Marshall is lower in males as compared to females. A number of ACVs were significantly related to weight of cadaver in males. Conclusions: The present study provides data of cardiac veins for various cardiac interventional procedures.
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Background: Nearly one third of people who suffer major psychiatric disorders end up with a long- term disability and dependency. They are most likely to be non-adherent to medication due to various reasons including lack of knowledge or insight about their illness and treatment which in turn leads to exacerbation of their illness, reduce treatment effectiveness, or make them less responsive to subsequent treatment, multiple hospitalizations and poor quality of life. Materials and methods: A cross sectional study was carried out in outpatients attending the Psychiatry OPD using the consecutive sampling technique. Subjects meeting the ICD-10 Diagnostic criteria for psychiatric disorders, age 18 year and above, subjects willing to participate in the study were included. A structured proforma, the Drug attitude inventory and the WHO-QOL-BREF questionnaires were used for assessment. Results: Mean age of subjects = 38.07 + 11.07 years. Mean medication cost = Rs. 917.82 + 397.89. 87 subjects participated in the study and of them 48% were adherent to medication and 52% were non-adherent. 56% of males and 43% females were adherent to medication. There was significant association between the occupation and the type of family of the subjects and medication adherence (p<0.05). Majority of patients with medication non-adherence were seen in schizophrenia, delusional disorder, bipolar disorder, generalized anxiety disorder, obsessive-compulsive disorder and substance related disorder. Majority (44.5%) of them reported fear of side effects, followed by stopping the medication when feeling better (35.5%) as the reasons for non-adherence followed by cost, embarrassment, etc. There was significant association between the psychological and social quality of life and medication adherence (p<0.05). Conclusions: This study implicates the importance of psycho education about the diagnosis, prognosis, need for medication and the expected adverse effects which should be clearly explained to the patient. The therapeutic alliance is the most effective component in helping the patient maintain medication adherence and subsequently better quality of life.
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Lilium polyphyllum D.Don ex Royle belonging to family Liliaceae is a medicinal plant distributed in temperate to high altitude regions of Himalaya. Its bulbs have been used for anti-aging and vitality properties in >30 formulations of Ayurveda. Therefore, the knowledge on various traits of the plant is necessary so that quality of the finished products could be maintained. Present study investigates, morphological, biochemical and antioxidant properties in different populations of L. polyphyllum. A significant variation was recorded in different morphological parameters (Plant height, leaf number, leaf length, leaf width, bulb diameter, bulb fresh weight). Variation was also recorded for total soluble protein (7.81-11.35 mg/g), soluble sugar (96.14-116.14 mg/g), starch (116.37-122.43 mg/g) and total free amino acid (18.22-26.00 mg/g). Antioxidant properties in the bulb were determined and ABTS activity was 4.22 mM /100 g, DPPH activity recorded 0.85 mM/100 g and FRAP activity was 1.50 mM/100 g dw ascorbic acid equivalent, respectively. The diversity in wild populations of the species may serve as a baseline data for future breeding, domestication and conservation program.
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Background: Post-COVID syndromes are the most abundant sequel of coronavirus disease of 2019 (COVID-19) infection, which affects millions of people around the whole world. There is a significant difference observed during the acute phase as well as during the post-COVID period between patients hospitalized with (alpha, delta, or omicron) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant. In the present scenario, when most people are vaccinated, COVID-19 disease is less likely, but the remnants of previous COVID-19 infections are still a vast health burden. Materials and methods: This prospective, observational, comparative, and analytical study included a total of 3,840 COVID-19-infected patients who visited the hospital. We included 1,150 patients of alpha variants, 1,845 patients of delta variants, and 815 patients of omicron variants, from June 2020 to November 2020, March 2021 to July 2021, and January 2022 to May 2022, respectively. All medical data of the study population, including hospital stay and vaccination status, were collected, and all patients were followed up for 6 months of duration. All collected data were compiled and analyzed to compare the post-COVID thrombotic and other events among different variants of COVID-19. Results: Patients infected during the delta variant are the most symptomatic at onset (higher prevalence of fever, dyspnea, cough, myalgia, headache, or gastrointestinal problems) than those infected with the alpha or omicron variant (p < 0.01). A total of 2,830 patients (7.48%) [1,520 (82.38%) of delta variant, 598 (73.37%) of omicron variant, and 712 (60.34%) of omicron variant] developed post-COVID syndrome during their follow-up period out of 3,220 enrolled patients and the difference was statistically significant when compared among variants (p < 0.05). In this study, the highly prevalent post-COVID syndrome was mucormycosis (11.41%), followed by new-onset diabetes (9.89%), pulmonary fibrosis (7.67%), ischemic heart disease (6.46%), brain stroke (3.29%), and other thromboembolic disorders (2.37%). Conclusion: COVID-19-associated onset symptoms during the delta variant were more severe and highly prevalent, while neurological symptoms (aguesia and anosmia) were more common during the alpha variant. Patients infected with the delta variant of COVID-19 are more prone to develop post-COVID-associated complications with minimal risk in the omicron variant and intermediate risk in the alpha variant. Long COVID-19 requires specific attention for management, irrespective of the SARS-CoV-2 variant.
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Tele-healthcare is need of the hour to bridge the vast healthcare gap in developing country like India. Being the second most populous country, quality healthcare facility is not easily accessible in the rural outskirts of India. In this research work the proposed system has acquired ECG, heart rate, SpO2 and body temperature data for better diagnosis and prognosis. The proposed system has been tested on the different patients belonging to different age groups and the result obtained on the health monitoring dashboard is found to be satisfactory. It also provides enhanced accessibility as multiple healthcare professionals can collaborate on the patient's data. This paper concludes with real time audio/ video connectivity, scope of interest of which is very effective and applicable in healthcare world.
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@#[Objective] To explore the application of Quality by Design (QbD) tools in assessing geographical variations of Phyllanthus emblica (P. emblica) from five distinct Indian states. [Methods] In the current experiment, the Box-Behnken design with a reduced quartic model and 105 runs was employed with the use of the Design Expert software for randomized response surface mapping. Three different extraction methods (Soxhlet, maceration, and sonication) along with three solventst [distilled water, methanol, and water-methanol mixture (50 : 50 v/v)] were considered in the present study. The anti-oxidant activities, total flavonoid content (TFC), and total phenolic content (TPC) in the P. emblica were determined and analysed by gas chromatography-mass spectrometry (GC-MS) to identify the major components. [Results] The QbD overlay plot showed that the extractive value of the P. emblica was no less than 30% w/w, 2,2-diphenyl-1-picrylhydrazyl (DPPH) no less than 60% mcg/mL (micrograms per millilitre), TFC no less than 75 mg QE/g (milligrams of quercetin equivalents per gram), and TPC no less than 80 mg GAE/g (milligrams of gallic acid equivalents per gram). Moreover, the GC-MS data confirmed the presence of variation in the bioactives of P. emblica extracts. [Conclusion] The model was significant in describing the variation in extractive value, DPPH, TFC, and TPC. The QbD approach may tend to prioritize thoroughness in the extraction process, ultimately resulting in improved quality in the extracted products.
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Introduction: Acute Kidney Injury is commonly present in Covid-19 hospitalised patients whereas chronic kidney disease and end-stage renal disease are also common comorbidities in patients who develop severe COVID-19. These patients require antiviral medication as early as possible but there is no current guidelines for use of Remdesivir therapy in these patents and drug is not used initially in these patients. Antiviral strategies are desperately needed in this population to treat these patients as early as possible. Material And Methods: We conducted an observational, retrospective cohort study of adults with COVID-19 confirmed by RT-PCR who had eGFR < 30mL/min/1.73m2 or received RRT prior to receiving at least one dose of Remdesivir. eGFR was estimated from the serum creatinine value just prior to the first dose of Remdesivir using the Chronic Kidney Disease Epidemiology Collaboration calculator. The majority of patients requiring supplemental oxygen were offered Remdesivir; eGFR cut-offs were not used as a strict exclusion criteria. All patients with eGFR < 30mL/min/1.73m2 who received at least one dose of Remdesivir in hospital were included in the study. AKI was defined as at least a 1.5- fold rise in creatinine from baseline per KDIGO criteria. CKD was defined as eGFR < 60mL/min/1.73m2 between 7-365 days prior to admission. Patients with “stable CKD” did not meet criteria for AKI at the time of starting Remdesivir. ESRD was defined as requiring RRT > 3 months prior to hospitalization. The primary objectives were to describe changes in ALT, AST, and Bilirubin and serum creatinine during Remdesivir therapy, and to report adverse effects attributed to Remdesivir. A Results: total of 41 patients with eGFR <30 ml/min per 1.73 m2 at the time of Remdesivir initiation were included in the study. 27 patients were in intensive care, and 14 patients were mechanically ventilated at the time of Remdesivir initiation. At the time of Remdesivir initiation, 30 patients were receiving RRT. 11 patients with eGFR <30 ml/min per 1.73 m2 were not on RRT at the time of starting Remdesivir. Four patients developed ALT more than the upper limit of normal and only two patients developed ALT more than 5 times, that may be contributory to other factor also. In general, limited information is available Conclusion: on the impact of SARS-CoV-2 infection in patients with eGFR less than 30. Impact of Remdesivir on these patients and their liver and kidney functions are not well studied. Although the available clinical data are limited, but it shows that impact of Remdesivir on liver and kidney function in patients of eGFR less than 30 is limited. However further studies are needed
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Background : Various studies have pinned longevity of protective Immunoglobulin-G (IgG) titres at 2-5 months. The robustness and longevity of the IgG antibody response to COVID-19 infection has been gauged in a cohort of 214 single institutional health care workers by serial quantitative immunometric tests. Currently no separate guidelines exist for vaccination of COVID-survivors and this study provides data to fill this lacuna in knowledge. Methodology : Prospective longitudinal panel survey administered to the same cohort of Health Care Workers (HCW) till such time they got vaccinated under Indian Government’s free vaccination drive for HCW. Depending upon the date of contraction of infection the HCW could be longitudinally monitored for variable periods (2-9 months). The survey questionnaire comprising multiple-choice, dichotomous, matrix and Likert-scale questions was deployed to the respondents online via email/WhatsApp. Data was expressed as box-whisker plots, trendlines and trend areas. A p-value<0.05 was considered statistically significant. The composite index of ‘Effective Immunity’ was calculated. Results : The mean IgG antibody titre was 11.13±8.6AU at 1-2m, 9.68±8.9AU at 3-4m, 8.35±5.9 AU at 6-7m and 7.87±4.4 AU at 8-9m after first symptom, respectively. The lowest titre at all time points was 0 while the highest titres were 46.8 AU, 56.5 AU, 23.4 AU and 17.4 AU at 1-2m, 3-4m, 6-7m and 8-9m, respectively. Conclusion : Adaptive active immunity acquired through natural infection may last for at least 9 months post-initial exposure and lies in the moderate protection range in 77% HCW, which can be extrapolated to vaccination and immunity passports. Separate vaccination guidelines are required for COVID-survivors. The first shot of vaccine serves as a booster second exposure/booster dose in all COVID-survivors.HCW with low IgG-titre may suffer from a false sense of security. Periodic quantitative IgG-titre based serological tests can help guide timing of second shot of vaccination and predict likelihood of re-infection
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Lipomas are the most common, subcutaneous, and slow-growing tumors composed of fat (adipose tissue). Out of many types of these benign tumors, ossifying lipoma (osteolipoma) is the rarest subtype. Here, randomly distributed trabeculae of lamellar bone are seen within mature adipose tissue. They are featured only as isolated case reports and small case series, thus the true incidence is not known. The most common site for osteolipoma is the head and neck region and they are rarely reported in the lower extremities. Herein, we discuss the case of a 19-year-old man who presented with a progressively enlarging painful mass in the left leg. Radiology was typical of osteoid osteoma. Excision was performed and histopathological examination confirmed the lesion as osteolipoma with no evidence of malignancy. No recurrence of the tumor was observed after 2 years of follow-up. Although osteolipoma is a rare entity, the differential diagnosis of the lesion can be kept in mind whenever we encounter ossification within the adipose tissue.
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Gallbladder tuberculosis (TB) is a rare disease, and it might be challenging to distinguish it from gallbladder cancer on clinical history and radiology. It frequently mimics carcinoma in patients who initially appear with a gallbladder mass. Gallbladder TB is only identified after histology of the resected specimen since radiography lacks pathognomic characteristics. Here, we describe a unique case of gallbladder TB that was incidentally identified when a 49-year-old lady was being evaluated for suspected gallbladder cancer. Histology of the gallbladder exhibits necrotizing granulomatous inflammation with the presence of numerous pink-colored, curved, and beaded acid-fast bacilli that were recognized on the Ziehl-Neelsen stain.
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BACKGROUND The traditional coronary calcium score (CCS) is a time-tested tool for the evaluation of coronary atherosclerosis and predictor of future cardiovascular events. Non-traditional tools can also have a value in predicting and detecting subclinical coronary artery disease (CAD). METHODS We studied the role of CCS, the traditional CAD risk predictor, and the less-recognized, non-traditional risk factors, i.e. epicardial fat volume (EFV) and thoracic extracoronary calcium (ECC), to assess the degree of subclinical CAD. In this cross-sectional observational study, we included 950 Indian patients (suspected to have CAD). Coronary computed tomography angiography was performed. Estimation of CCS, EFV and thoracic ECC was done. RESULTS A CCS of 0 was seen in 583 patients (61.4%). Of these, 492 patients had normal coronary angiogram but 91 patients had CAD. The median values of EFV were statistically significantly higher in the ‘CAD present and CCS 0’ group compared to the ‘CAD absent and CCS 0’ group (p<0.001). The presence of thoracic ECC involving at least a single site was seen in only 6 of these 91 patients. When both EFV and CCS were considered together for the detection of CAD, the sensitivity and negative predictive value (NPV) were improved compared to either of these in isolation. When ECC was taken together with CCS and EFV, no further improvement in sensitivity or NPV was observed. CONCLUSION The combined use of traditional CCS along with non-traditional EFV may guide us in better profiling cardiovascular risk and supplement the various traditional cardiovascular risk factors/scores.
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Despite being a rare condition, Dieulafoy's lesion, also known as the persistent artery, is a serious cause of gastrointestinal bleeding. Only 1–2% of acute gastrointestinal bleeding is caused by it. Most commonly affects the stomach and duodenum, rarely affecting jejunum, ileum, caecum, etc. Our case presents a 21-year-old male who presented with lower gastrointestinal bleeding secondary to jejunal dieulafoy’s lesion.
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Follicular dendritic cell sarcoma is a rare histiocytic and dendritic neoplasm mainly involving the lymph nodes and selective extranodal sites. They are often misdiagnosed due to nonspecific clinical, radiological, and morphological findings in addition to their rarity. Four cases described below had variable age of presentation, site of involvement, size of the lesion, and histopathological features. Application of an extensive immunohistochemical panel, including a combination of >1 dendritic cell marker, clinched the diagnosis. A combination of D2-40 and Cluster of differentiation 21 (CD21) worked best in establishing a definite role in the current series. Programmed death-ligand 1 (PD-L1) analysis was positive in two of the three cases where it could be performed. However, none of our cases had received immunotherapy. Prompt recognition of the described histopathology features and incorporation of novel immunohistochemical markers can translate to timely initiation of therapy for this aggressive disease
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Background: Dengue infection is a disease that progresses rapidly to life-threatening conditions. Our goal was to develop a practical scoring system based on clinical profiles and routine tests to predict the severity of infection. Methods: This cross-sectional observational study included 500 patients with dengue infection. Patient demographics, clinical symptoms, regular laboratory tests, and results were collected. Dengue infections are divided into three classes, depending on their severity: dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS). Based on the total score, patients were divided into three severities. Results: Patients with DSS and DHF scored higher with worsening clinical features and routine laboratory tests compared to DF. Clinical predictors of severity include older age, increased white blood cell (WBC) count, increased hematocrit, increased prothrombin time, decreased platelet count, decreased blood pressure, presence of peri-gallbladder (GB) edema, third space loss, hepatomegaly, and other organ involvement. The severity range is 0–12, and the score is 0–3 for DF, 4–8 for DHF, and 9–12 for DSS. Based on the derived scores, patients were classified according to their original severity in 63% of cases. Conclusion: This dengue infection severity scores correctly classified patients according to their original severity grade of DF, DHF, or DSS. This scoring system helps to quickly assess dengue infections and start treatment according to the correct severity category.
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Diabetes self-management education (DSME), an integral part of diabetes management is delivered by trained educators in well-developed countries. Unfortunately, there is a dearth of an organized, concise and easy-to-deliver diabetes education module in India. The relationship between diabetes self-care and glycemic control has been studied extensively. The present review discusses an innovative diabetes self-education training module that can be easily reciprocated by others to benefit the larger population.
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Objective: To compare two methods of tubal sterilization; modi?ed Pomeroy and a modi?cation added to modi?ed Pomeroy's method, in a low resource setting. In this prospective study conducted from Methods: 2019 to 2021 in one thousand women, we compared Pomeroy's method with an other method in which a slight modi?cation in the original modi?ed Pomeroy's technique was introduced, in a very low resource rural community hospital with only basic operation theater facility. In modi?ed Pomeroy's method, a loop of fallopian tube is resected and trans?xed with 2-0 chromic catgut surgical suture material. In our study we added another modi?cation to the modi?ed Pomeroy's method, wherein the proximal end of the fallopian tube was additionally ligated with a 2-0 silk suture. The patients were followed up from 6months-2 years. A failure rate of 0.4% was observed in women who underwent Modi?ed Pomeroy's method in contrast to no Results: failure in women in whom the proximal end of the tube was additionally ligated. Additional modi?cation to the Conclusion: original modi?ed Pomeroy's method of sterilization can be potentially promising in reduction of sterilization failure rate in parts of world where salpingectomy is less readily accepted
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Background: Depression is a commonly prevailing condition that goes undetected in clinical settings. Both abdominal obesity and periodontal disease have a bearing on mental health and have an impact on the quality of life. Objective: To assess the level of clinical depression in abdominally obese subjects with periodontal disease. Methods: Two hundred and ten subjects with a mean age of 37.45 ± 9.59 years (males = 117; females = 93) were grouped as per their abdominal obesity and periodontal status and assessed for their clinical depression levels (mental health) using the Centre for Epidemiologic Studies?Depression Scale (CES?D). Collected data were analysed. Results: The clinical depression score significantly varied in subjects with different periodontal status in both non?obese (F (2,102) = 113.66, P < 0.0001) and abdominally obese subjects (F (2,102) = 132.04, P < 0.001). Significantly higher depression score was demonstrated in healthy (P < 0.001), gingivitis (P < 0.001), and periodontitis (P < 0.001) groups in abdominally obese subjects. Conclusion: Clinical depression is significantly associated with abdominal obesity and periodontal disease in subjects with abdominal obesity and severe periodontal disease demonstrating higher depression scores