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Transgender care needs a multidisciplinary team approach. The awareness about transgender health has increased over the past few years in India. The pyramid of transgender health helps to demystify the care of transgender individuals. The 7 S's of lifestyle modification need to be followed in the routine clinical care of transgender individuals. The individuals also need psychological care and support, metabolic and medical care, endocrine management, and later surgery in some cases. The policy makers can use the pyramid to decide about financial help to the community for their holistic care. The physicians involved in the care of transgender individuals can also take guidance about comprehensive care and management of transgender and gender diverse individuals.
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Background: Chronic kidney disease (CKD), due to increasing frequency and prevalence, has become one of the leading public health issues. The Kidney Disease Outcome Quality Initiative (KDOQI) defines CKD as kidney injury or a reduction in the glomerular filtration rate (GFR) to <60 mL/minute/1.73 m2 for at least 3 months. This study aims to compare the effects of decreased renal function on thyroid profile and lipid profile in CKD patients. Materials and methods: This is a prospective cross-sectional observational study conducted among the patients attending Outpatient Department/Inpatient Department (OPD/IPD) at the School of Medical Sciences & Research, Sharda Hospital, Greater Noida, Uttar Pradesh, India, in known cases of CKD, irrespective of the treatment/stage of CKD. All patients of >18 years of age with CKD were included in the study. Result: A total of 200 patients who met the inclusion criteria were included after obtaining detailed informed consent, of which 100 were cases and 100 were controls. The mean age of patients in the study was 47.74 years, with the mean age in patients with CKD 52 years, and the control was 43 years. The mean level of triglycerides (TGs) was significantly higher among the cases, and the high-density lipoprotein (HDL) was significantly lower among cases compared to controls (p < 0.05). Pearson’s correlation between thyroid-stimulating hormone (TSH) with creatinine showed a weak albeit significant positive association (r = 0.200; p < 0.05). Conclusion: Our study shows a higher incidence of alteration in thyroid profile and dyslipidemia among the patients with CKD compared to controls. There is a necessary need to screen routinely for hypothyroidism and dyslipidemia among patients with CKD. Importantly, thyroid hormone levels and their effects on the progression of CKD have not been studied exhaustively.
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Adverse cardiac remodeling refers to progressive structural and functional modifications in the heart because of increased wall stress in the myocardium, loss of viable myocardium, and neurohormonal stimulation. The guideline-directed medical therapy for Heart failure (HF) includes Angiotensin receptor-neprilysin inhibitor (ARNI) (sacubitril/valsartan), ?-blockers, sodium-glucose co-transporter 2 (SGLT2) inhibitors, and mineralocorticoid receptor antagonists (MRA). ARNI is under-prescribed in India despite its attractive safety and efficacy profile. Therefore, the consensus discusses objectives and topics related to ARNI in the management of cardiac remodeling, and experts shared their views on the early timely intervention of effective dosage of ARNI to improve the diagnosis and enhance mortality and morbidity benefits in cardiac reverse remodeling (CRR).
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Iron deficiency (ID) with or without anemia is frequently observed in patients with heart failure (HF). Uncorrected ID is associated with higher hospitalization and mortality in patients with acute HF (AHF) and chronic HF (CHF). Hence, in addition to chronic renal insufficiency, anemia, and diabetes, ID appears as a novel comorbidity and a treatment target of CHF. Intravenous (IV) ferric carboxymaltose (FCM) reduces the hospitalization risk due to HF worsening and improves functional capacity and quality of life (QOL) in HF patients. The current consensus document provides criteria, an expert opinion on the diagnosis of ID in HF, patient profiles for IV FCM, and correct administration and monitoring of such patients.
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Ephs belong to the largest family of receptor tyrosine kinase and are highly conserved both sequentially and structurally. The structural organization of Eph is similar to other receptor tyrosine kinases; constituting the extracellular ligand binding domain, a fibronectin domain followed by intracellular juxtamembrane kinase, and SAM domain. Eph binds to respective ephrin ligand, through the ligand binding domain and forms a tetrameric complex to activate the kinase domain. Eph-ephrin regulates many downstream pathways that lead to physiological events such as cell migration, proliferation, and growth. Therefore, considering the importance of Eph-ephrin class of protein in tumorigenesis, 7,620 clinically reported missense mutations belonging to the class of variables of unknown significance were retrieved from cBioPortal and evaluated for pathogenicity. Thirty-two mutations predicted to be pathogenic using SIFT, Polyphen-2, PROVEAN, SNPs&GO, PMut, iSTABLE, and PremPS in-silico tools were found located either in critical functional regions or encompassing interactions at the binding interface of Eph-ephrin. However, seven were reported in nonsmall cell lung cancer (NSCLC). Considering the relevance of receptor tyrosine kinases and Eph in NSCLC, these seven mutations were assessed for change in the folding pattern using molecular dynamic simulation. Structural alterations, stability, flexibility, compactness, and solvent-exposed area was observed in EphA3 Trp790Cys, EphA7 Leu749Phe, EphB1 Gly685Cys, EphB4 Val748Ala, and Ephrin A2 Trp112Cys. Hence, it can be concluded that the evaluated mutations have potential to alter the folding pattern and thus can be further validated by in-vitro, structural and in-vivo studies for clinical management.
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Objective: To assess whether simulation based education (SBE) improves the practices and knowledge of junior residents for stabilization of a preterm neonate in delivery room as compared to conventional education (CE). Methods: This trial randomized 24 pediatric residents to either SBE (n=12) or CE (n=12) groups. One-time SBE was imparted to the SBE group. Both the groups had similar facilitator participant ratio and equally timed sessions. The individual skills scores and performance by preterm stabilization performance evaluation (PSPE) score in real time were recorded using a validated tool within 8 weeks of the training. Knowledge gain was evaluated using pre and post-test scores. Results: The mean (SD) skill and PSPE scores were comparable between the two groups (skill score 51.1 (8.1), 46.5 (7.8), respectively mean difference 4.6; 95% CI -2.1 to 11.3; PSPE-score 80.2 (14.2) vs. 82.9 (10.3); mean difference -2.68; 95% CI -8.35 to 13.71). The mean (SD) knowledge gain was similar in the groups [4.4 (1.9), 5.3 (4.1); mean difference 0.91; 95% CI, -1.81 to 3.64. Conclusion: In junior residents, a one-time SBE session, when compared to conventional task training, did not lead to improvement in the performance of the initial steps of neonatal resuscitation.
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Background: If properly used in appendicitis, antibiotics can reduce the rate of infection by 50%. The use of post-operative antibiotics for preventing infective complications in non-perforated cases is still controversial.Methods: A randomised prospective study was conducted in the Department of Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi with patients who presented acute appendicitis. A minimum number of 30 patients each in group A (pre-operative and post-operative antibiotics) and group B (only pre-operative antibiotics) were evaluated for 18 months, from January 2018 to June 2019.Results: The mean age of group A is 29.9±15.16 years and in group B is 25.97±9.470 years (p value=0.122, insignificant). There was male preponderance. The seroma formation in both the groups was 10.00% and no patients developed intra-abdominal abscess. The incidence of local site oedema was 10% in both the groups A and B and their p value is insignificant. In both the groups A and B, 10% of the people developed pus discharge from the stitch line and the p value is insignificant. In group A, 6.67% of the patients and in group B 10.00% of the patients developed stitch line inflammatory changes and the p value insignificant. In group A, 13.3% and in group B, 10.00% of the patients developed fever and their p value is 1. The mean length of hospital in case 1.23±0.5 days (group A) and is 1.17±0.45 days (group B) (p value=0.508).Conclusions: Hence we can conclude that a well-chosen and adequately-timed pre-operative antibiotics are adequate in preventing post-operative complications and post-operative antibiotics do not affect the same.
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Background: Traditional method of learning via face to face lecture has been in curriculum since timesimmemorial. E-learning via multimedia has been a recent introduction in education system. Purpose: Tocompare e-learning with the traditional method of teaching in medical education. Material and Methods: Thetwo different methods of teaching were applied on the same group of students. A total of six lectures wereconducted. Three of them were taught by traditional method of teaching and three by e-leaning. Formativeassessment in the form of written examination was carried out, followed by qualitative assessment at the endof session. Results: The mean marks obtained after Exam-1 (i.e. following traditional teaching method) was6.46 ± 1.48 and mean marks obtained after Exam-2 (i.e. following e-learning) was 8.37 ± 1.27. The meandifference score was 1.91 ± 1.55. The paired t-test was applied, and the value of t was 11.96 with p-value<0.001. The results between two teaching methods were statistically significant. For qualitative analysisLikert scale was used. 66% of students strongly agreed that e-learning is a superior method than traditionalmethod of learning. Conclusion: The e-learning proved to be more efficient and uniform method of studentlearning with revision facilities.
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Context: Spirometry is an important tool to monitor treatment response in diseases such as chronic obstructive pulmonary disease and asthma. However, there is lack of evidence to support its application to evaluate response to chemotherapy in advanced lung cancer. It might be a useful adjunct to the imaging-based response evaluation which lacks functional assessment of lungs. Aims: The study was conducted to evaluate the change in spirometry in lung cancer patients after chemotherapy and to find its correlation with change in physical tumor size. Subjects and Methods: Sixty-two advanced lung cancer patients who were eligible for palliative chemotherapy were enrolled. Baseline tumor size evaluation using Response Evaluation Criteria in Solid Tumor (RECIST)-based scoring system, and spirometry was done. Four cycles of double agent (platinum doublets) chemotherapy were administered, after which treatment response was evaluated. Repeat spirometry was analyzed and correlated with changes in physical tumor size. Results: Twenty-five patients showed a response (all partial response) to four cycles of chemotherapy. Small cell carcinoma showed a better response rate than non-small cell carcinoma (78% vs. 39%). There was statistically significant improvement in forced expiratory volume in 1 (FEV1) (P = 0.01) and forced vital capacity (P = 0.03) in responders as compared to nonresponders. Change in FEV1 showed a statistically significant correlation with the change in tumor size (RECIST score) (r = –0.34; P = 0.04). Conclusions: Improvement in spirometry correlates with the tumor response as judged using RECIST criteria after chemotherapy. Further studies with bigger sample size are required to consolidate the results
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Background: Women with adnexal masses can present with acute symptoms such as abdominal pain, nausea and vomiting. As there is insufficient evidence on the frequency, presentation and management of adnexal masses we conducted this study to evaluate the clinical profile, surgical findings and histopathology of adnexal masses in women presenting with acute abdomen and needing surgical intervention.Methods: In this prospective observational study, history, examination, investigations and ultrasound of abdomen and pelvis were evaluated in women presenting with acute abdomen with adnexal mass and needing surgical intervention. Diagnosis was confirmed from the operative findings and histopathology. Etiology and its correlation with clinical symptoms and signs and radiological diagnosis formed the primary objective of the study.Results: Of the 79 patients enrolled in the study, the mean age was 30.82±6.69 years. Younger women were likely to have ectopic pregnancy while older women (>35 years) other tubal pathologies. Pain abdomen (n=70) and nausea (n=53), bleeding per vagina(n=33), menstrual irregularities (n=18), fever (n=10) abdominal distension (n=10) and dysuria (4) were the common symptoms. Etiology of the adnexal mass was ectopic pregnancy (57%), ovarian mass (34%), tubal mass (7.5%), tube and ovary (2.5%) in 46, 25, 6 and 2 patients respectively. 61% (n=48) of the women underwent laparoscopic management. Women with ruptured ectopic pregnancy were more likely to have abdominal distension, pallor, hypotension, cervical motion tenderness and need for blood transfusions.Conclusions: In women from reproductive age group with adnexal mass and needing surgery, ectopic pregnancies and benign ovarian tumours were the common etiologies. Urine pregnancy test and ultrasound are useful tests to differentiate ectopic from ovarian and tubal pathology.
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Yolk sac is the first anatomical structure identified within the gestational sac at 5+ weeks and is diagnostic of intrauterine pregnancy. It is attached through the yolk stalk with the intestinal cavity of the embryo and is supplied with blood vessels that transport nutritive yolk products to the developing embryo. It provides nutritive, metabolic, endocrine, immunological and haemopoietic functions. The poor quality and early regression of a yolk sac in presence of embryonic heart beats are more specific than the large size of a yolk sac in predicting pregnancy loss. Number of yolk sac is usually indicative of amnionicity, except in select reported cases of monoamniotic twins when two yolk sacs are present. Singleton pregnancies contain only one yolk sac as a rule. We have come across a case of elderly non-diabetic primi gravida where presence of one extra yolk sac has accelerated growth of single foetus by 8 days in early first trimester. We followed it up to 16 weeks of gestation when both yolk sacs disappeared. It was concluded that two yolk sacs conferred extra mileage of growth to the foetus due to doubled yolk sac functions, and this extra growth persisted throughout.
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Objective: To evaluate the clinical profile and predictors of mortality in neonates withcongenital diaphragmatic hernia (CDH). Method: Demographic and clinical parameters ofneonates with congenital diaphragmatic heria (n=37) between January 2014 and October,2017 were reviewed, and compared among those who survived or expired in hospital.Result: Median (range) gestation and birthweight were 38 (37-39) weeks and 2496 (2044-2889) g, respectively. Persistent pulmonary hypertension (PPHN) was documented in 19(51%) neonates and 10 (27%) had associated malformations. Surgery could be performed in18 (49%), overall mortality was 60%. On univariate analysis, low Apgar scores, presence ofmalformations, PPHN, need for higher initial peak inspiratory pressure/high frequencyventilation, and requirement of a patch for closure were associated with increased mortality.On multivariate analysis, PPHN remained the only significant risk factor [adjusted RR 3.74(95% CI 1.45-9.68)]. Conclusion: The survival of infants with CDH is low, and PPHN is animportant predictor of mortality.
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Objective: The aim of the study was to find how affected is the unaffected side of stroke population. Methods: 20 participants were recruited who met the inclusion criteria of more than 3-month first time unilateral both male and female stroke patients of age group 40-60 years were assessed and evaluated for the 3 parameters using grip dynamometer, peg board and reaction time machine respectively and compared it to the normal healthy age, gender and dominance matched individuals. Results: The unaffected side of stroke patients was significantly affected in gross motor strength, fine motor dexterity, reaction time audio and visual when compared to normal population. Conclusion: There are significant motor deficits seen in the unaffected side of stroke patients.
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Background: India is a vast country with four geographical zones. Zonal heterogeneity amongst prevalent adult glomerular diseases is expected and has not been analysed in past studies.Methods: We conducted clinico-histological correlation of 290 kidney biopsies for adult glomerular diseases (GD) at tertiary teaching hospital in Eastern India between January 2013 and December 2015 and compared our data with biopsy data from other geographical zones in India to evaluate zonal variability (intra/inter) of adult glomerular diseases.Results: Males dominated all clinical syndromes except subnephrotic proteinuria (SbNP). IgA Nephropathy (IgAN, 41.1%) and Focal Segmental glomerulosclerosis (FSGS, 17.3%) were prevalent primary GD whereas Lupus nephritis (LN, 52.2%) and diabetic nephropathy (DN, 23.9%) were prevalent secondary GD. IgAN (44.4%) and LN (33.2%) dominated SbNP group whereas FSGS (30.2%) and Membranous nephropathy (MGN, 22.3%) dominated nephrotics. Mean eGFR (CKD-EPI) amongst EyRD and RPRF was 39.6±12.9 and 6.2±2.9 ml/min/1.73m2 respectively. In contrast, biopsies from East India showed MCD prevalence, followed by FSGS. Kidney biopsy data from West India showed MCD prevalence whereas Northern India and South India studies showed FSGS and MCD prevalence, but later data showed an IgAN emergence, as in our data.Conclusions: There is considerable heterogeneity in prevalent adult glomerular diseases in different geographical zones (inter and intra) in India. FSGS and MCD were the most prevalent in all zones. Our study showed IgAN prevalence in East Zone, similar to South India. Reason was, increased number of kidney biopsies in EyRD (eGFR 30-60 ml/min) and subnephrotic proteinuria.
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Background: Shoulder pain due to its high prevalence has great significance in its contribution to morbidity. It’s the third most common musculoskeletal problem.There are two types of trigger points found they are active and latent trigger points.Active trigger points are the one which when palpated causes spontaneous pain or referred pain and latent trigger points are the one which do not cause any pain except they are present either in form of taut band or nodules. MyofascialTrigger points (MTrPs) cause a local pain syndrome. The main cause of myofascial pain syndrome are trigger points. Purpose of the study: The purpose of the study was to determine the exact muscles that have the tendency for developing trigger points in acute shoulder pain pathologies and to see the trigger points developed are due to the shoulder pathology. Materials and Methods: A observational study was performed. Patients were selected by convenient sampling. 70 people participated within the age of 18-65, pain duration within 3 months, males and female included with no history of recent trauma, neurovascular injuries, degenerative pathology and shoulder dislocation. Patients were assessed for myofascial trigger points (MTrPs) on both affected and non-affected side. MTrPs were assessed on different muscles by manual palpation method. Results: The result shows that the muscle affected maximum is upper trapezius with 84.28% and pectoralis major with 71.42%. Also on the affected side, upper trapezius with 37.14% and pectoralis major and subscapularis with 20.00%. Conclusion: This study showed the prevalence of trigger points in acute shoulder pain pathologies is66.59% . Each patient of any acute pathology had the presence of more than 3 trigger points in the affected side proving trigger points to be of significant importance and it is due to underlying shoulder pathology.
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Background: The main purpose of the study was to find out the different joints affected in the truck drivers and the associated-risk factors for musculoskeletal pain in this population due to the paucity of literature pertaining to Indian truck drivers.Methods: A self-administered closed-ended validated questionnaire was prepared by the researcher incorporated with Nordic musculoskeletal questionnaire and numeric pain rating scale and the participants were questioned using the same questionnaire and response was recorded by the researcher.Results: This study found a prevalence rate of work-related musculoskeletal pain to be 76.92% in truck drivers and the most commonly affected joints are lower back followed by the knee, shoulder and cervical spine. The factors which are found to be responsible for work related musculoskeletal pain in truck drivers are age, years of driving, number of driving days in a week, number of driving hours in a day, rest duration, posture, stress, vibration & poor condition of roads.Conclusions: It can be concluded from the results of this study that extrinsic factors do play a significant role in the causation of work-related musculoskeletal pain in truck drivers and are a leading cause for affecting the health of truck drivers and a frequent cause of sickness absente
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Background: Backache is a common cause of morbidity among doctors and 50% of the obstetricians and gynaecologists suffering from this attribute it to working posture. Occupational injuries are poorly analyzed amongst these professionals. Work related injuries have adverse effect on health and work performance due to discomfort caused by pain. Awareness of ergonomics, correct posture and strategical assessment of risk factors is needed for the prevention of work related musculoskeletal injuries amongst obstetricians and gynaecologists.Methods: A survey based study was performed. Informed consent was taken for participation. The questionnaire included 16 questions categorised into: demographics; injury data; impact of injury; and general mental health. Hard copy of the questionnaire and online forms of the questionnaire were used to complete the data collection.Results: The response rate for the survey was 85% of the doctors who reported to have experienced pain in the last year. The most common site was back, which was followed by the neck and knees. 71.4% of doctors reported injuries attributed to work.Conclusions: The result demonstrates the prevalence of work related musculoskeletal injuries and their effects. These injuries are highly underreported. Ergonomics and work related injury prevention in this profession is a suggestion for solution as more data is needed regarding the analysis and risk factor assessment.
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Background: Flight attendants are the cabin crew members working in different commercial airlines. Their main job is to ensure safety and comfort of all the passengers. They are exposed to certain ergonomic stressors like long standing, irregular working hours and working in confined spaces and thus are likely to experience work related musculoskeletal disorders. The purpose of this study was to find out the prevalence and risk factors for work related musculoskeletal disorders in flight attendants.Methods: A survey-based study was performed. Self-made questionnaire was used and was validated by 3 experts in the Physiotherapy field. Workplace stress scale was also used to determine the level of mental stress that they experience. Informed consent was taken by each flight attendant participating in the study. Questionnaire was given to flight attendants working for different airlines like Spice Jet, Air India and Jet Airways. Hard copy of the questionnaire and online forms of the questionnaire were used to complete the data collection.Results: A total of 82% flight attendants reported to have work related pain in one or more body regions. Pain was commonly reported in feet and ankle, lower back and neck. Common risk factors were lack of rest breaks, prolonged standing/long working hours, wearing heels and mental stress.Conclusions: Thus, the study shows high prevalence of work-related musculoskeletal disorders in flight attendants.
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Transverse myelitis (TM) has been reported in association with vaccination, including post-diphtheria, pertussis, and tetanus (DPTw) vaccination. Here, we report the case of a 21-month-old female child presented with loss of neck control with a history of DPTw booster vaccination approximately 4 weeks before this illness. The child was referred to the tertiary care service hospital. Magnetic resonance imaging of the spine revealed longitudinally extensive TM in the cervical segment. Extensive investigation effectively excluded causes other than vaccination-associated TM. Following treatment with corticosteroids and intravenous immune-globulin, the child had a complete recovery. Early diagnosis and prompt treatment with immunotherapy are associated with a good outcome
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Background: Cereal venous sinus thrombosis (CVST) is the formation of blood clot in the dural venous and/or sinuses, which drain blood from the ain. It is one of the commonest causes of stroke in young. In most cases it hypercoagulable factors are responsible for it. Materials & methods: prospective observational hospital based study in the department of Neurology, S.C.B. Medical College & Hospital, Cuttack, odisha from October 2015 to September 2017. Those patients with diagnosis of CVST with magnetic resonance imaging and venogram confirmation with thrombophilia profile were included in the study. Thrombophilia assay was done. They were treated with recent guidelines. All the data were analyzed according to spss software version 20.0. Results: Total 24 patients did the profile. Most common age group was 21–40 yrs. Protein s was the most common factor. Transverse sinus was the most common sinus. Multifactorial thrombofilia patients were more resistant to therapy. Conclusion: All the CVST patients must be exposed to thrombophilia profile assay. It will not only help treatment of the disease but also it will help in prognosticate the outcome. In our area protein S deficiency is the most common factor abnormality. Further large studies are needed to obtain further knowledge about the factors and their clinicoradiological correlation.