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Myopia is a major public health problem worldwide, including India, with the global prevalence of myopia increasing rapidly over decades. The clinical and socioeconomic impact of myopia is also expected to rise with rising prevalence. Therefore, the focus has now been shifted to prevent the incidence and progression of myopia. However, there is lack of any standardized guidelines for myopia management. This document aims to generate a national-level expert consensus statement on the management of childhood myopia in the Indian scenario. The expert panel of pediatric ophthalmologists consisted of 63 members who met in a hybrid meeting. A list of topics deliberating discussion in the meeting was provided to the experts in advance and they were instructed to provide their opinions on the matter during the meet. The panel of experts then gave their views on each of the items presented, deliberated on different aspects of childhood myopia, and reached a consensus regarding the practice patterns in the Indian scenario. In case of opposing views or lack of a clear consensus, we undertook further discussion and evaluated literature to help arrive at a consensus. A written document is prepared based on recommendations explaining definition of myopia, refraction techniques, components and methods of workup, initiation of anti-myopia treatment, type and timing of interventions, follow-up schedule, and indications for revised or combination treatment. This article formulates evidence-based guidelines for progressing myopes and pre-myopes and also establishes uniformity in the management of childhood myopia in the country.
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Introduction: The preanesthetic evaluation, documenting it and maintaining the record is the responsibility of anesthetist. Better documentation practices can improve the patient's outcome. It has the pivotal role in medicolegal aspects. However, the documentation is one of the challenges when it comes to quality of care. The objective of the study was to assess the practice of documentation at preanesthetic evaluation and completeness of Preanesthetic evaluation tools. The descriptive study was conducted in tertiary care hospital. Modied global quality index (GQI) isMethod: used to prepare the Predefined twenty-two indicators. The data analysis is done using SPSS version-20. A total ofResult: 300 pre-anesthetic evaluation tools (PAETs) were reviewed. There was different trend in terms of completion rate for elective and emergency cases. However, there was no PAETs found complete. Indicators with high completion rate (>90%) were signed a consent, past medical history (PMH), history of medication, allergy, surgical procedure, cardiovascular examination, airway examination and respiratory examination. Anesthetic plan, premedication, vital signs, a name, per-oral status and age were found with below average (<50%) completion rate. andConclusion recommendations: Documentation during the preanesthetic visit observed below the standard. Which need to be standardized for uniformity. Use of electronic system with prefilled formats and training of personnel involved in the process is the way forward
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Introduction: A modified frenal treatment for aberrant frenum is presented in this report to reduce scar tissue formation and maintain the attached gingiva. Description: The case report describes two cases in which a V-shaped incision removed the aberrant frenum and then the flaps of the frenum were sutured at the mid line. Results: The results showed reduced scar tissue in the mid line and the tissue healed with adequate attached gingiva. Take-Away Lessons: The modified frenotomy technique presented here is ideal for a large frenum that could expose the underlying connective tissue that could reduce the scar tissue formation.
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Background:The prevalence of diabetes mellitus, is a major health concern that affects people around the world, and is increasing yearly. When blood glucose levels go below normal, a condition known as hypoglycemia, an immediate consequence of diabetes mellitus, occurs. The International Diabetes Federation reported thatthere were 451 million diabetics globally in 2017 and by 2045, it is anticipated that there will be 693 million. The objective of this study was to assess the level of knowledge of diabetic patient regarding hypoglycaemia and to find out the association between the levels of knowledge of diabetic patient on hypoglycaemia with their selected demographic variable.Methods:A descriptive cross-sectional study, was carried out in the month of June 2022. A semi-structured questionnaire was used to interview 100 study participants who were diabetes patients who had been admitted to the medical ward and who had visited the endocrinology outpatient department.Results:52% of the samples had fair knowledge on hypoglycemia, while 23% of them had poor knowledge. Demographic variable such as age, income, treatment, frequency of taking medicine, experience of symptoms of hypoglycemia and dietary habit were statistically significant with the level of knowledge, p<0.05.Conclusions:The study's findings highlighted the fact that most diabetes mellitus patients had a fair understanding of hypoglycemia. The health care personnel should also take time and efforts to educate patients about the sign of hypoglycemia. So that hypoglycemic episodes and morbidity could be reduced or prevented at primordial level.
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A 61-year-old male presented with sudden loss of vision in both the eyes about 8 days after the first shot of coronavirus disease 2019 (COVID-19) vaccine (Covishield). On examination, the visual acuity was no perception of light in both the eyes. Contrast-enhanced magnetic resonance imaging (MRI) with diffusion-weighted imaging showed acute cerebral infarcts involving bilateral parieto-occipital region. Considering the temporal correlation with the vaccine shot and absence of any other precipitating factor, we hypothesized that this was probably an immunologic response to the vaccine.
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Introduction: Of the total population, elderly people comprised of 8.14% in India where in India or globally. Main challenges faced by the elderly in our country are feminization, ruralisation, migration, and an increasing number of 80?plus adults. This sudden change of environment or being left stranded alone unattended or being dependent on children for their necessities is a major cause of mental illnesses. Objectives: To study the socio?demographic profile, find out the different morbidities and assess the health?seeking behaviour of the study subjects. Materials and Methods: A community?based cross?sectional study was conducted in the field practice area of urban health and training center using the simple random sampling method. Results: The mean age of study subjects was 67.58 ± 6.53 years. Majority of participants, i.e., 308 (73.0%) were young old. 207 (49.1%) were illiterate, 272 (64.5%) unemployed 272 (64.5%) and 224 (53.1%) were living with their children, i.e., 224 (53.1%). Inappropriate health?seeking behavior was significantly associated with under?weight (P < 0.001) which accounted for 2/3rd of participants. Severe depression was observed among 59.5% participants. Females showed a higher proportion of myalgia (5.7%), whereas males showed preponderance of upper respiratory tract diseases (19.2%). The prevalence of inappropriate health?seeking behavior was higher in females (65.1%). The proportion of the elderly with poor health?seeking behavior was found to be 50.4%. Conclusion: Morbidity among the elderly is very high and health?seeking behavior is very poor. Hence, strong efforts are needed to provide them holistic care. Hence, this study was conducted to threw some light on health status of the elderly, their morbidity pattern and health?seeking behavior. It will help the policy-makers to prepare the intervention strategies at the community level.
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Development of the primary and permanent dentition is a complex process wherein there is series of interactions between the ectoderm and ectomesenchyme. A cascade of signaling pathways occur in a spatio-temporal manner resulting in the development and eruption of the human dentition. Any developmental aberrations in shape, size, number, and position can lead to deviations from normal development of teeth. In this book, dental anomalies including gemination, fusion, concrescence, dilaceration, dens invaginatus, DE, taurodontism, enamel pearls, fluorosis, peg?shaped laterals, dentinal dysplasia, regional odontodysplasia and hypodontia etc. are discussed. Diagnosing dental abnormality needs a thorough evaluation of the patient and careful clinical and radiographical examination is required. Furthermore, more complex cases need multidisciplinary planning and treatment.
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Introduction: For the diagnosis of diabetes mellitus, various tests are available such as FBS (Fasting blood sugar), PPBS ( Post Prandial Blood Sugar), Oral Glucose Tolerance Test, Random Plasma Glucose Test, HBA1c, etc, of which HBA1c is considered to be the most standard test.1,2 As diabetes mellitus can be asymptomatic initially, it can lead to important complications such as neuropathy, nephropathy, retinopathy, cardiovascular diseases, etc if not detected early.3 Postural blood pressure measurement which diagnoses orthostatic hypotension is a cheap, easy and useful tool to predict HBA1c level even in asymptomatic diabetic patients. Methods: This is a randomized cross-sectional study of 100 diabetic patients attending Medicine OPD or admitted in our tertiary care hospital of South Gujarat. Pretested proforma was used to collect data after taking informed consent. Investigations including blood pressure measured with a standard Sphygmomanometer at the end of 3 min after standing and HBA1c as mentioned in the proforma was carried out. Final analysis has been done with Open EPI and SPSS software. Results: 33% of patients of our study population were found with abnormal orthostatic hypotension. Our data shows orthostatic hypotension is directly associated with high HbA1c, longer duration of DM, and higher value of BMI. No correlation was found between age and gender. Conclusion: Among diabetic patients, high HbA1c, prolong duration of DM and high BMI were associated with abnormal orthostatic hypotension, which can be alarming sign of complications of diabetes mellitus.
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A 36?year?old female presented with blurring of vision in one eye for 10 days after 1 month of an episode of COVID?19 infection. Her fundus showed disc edema with blurring of margins along with exudation around the fovea. Her C?reactive protein levels were raised. She responded well to oral steroids. A likely association with COVID?19 infection and its associated immune response was suspected.
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OBJECTIVE@#"Multi-targeting" drugs can prove fruitful to combat drug-resistance of multifactorial disease-cervical cancer. This study envisioned to reveal if Thuja homeopathic mother tincture (MT) and its bioactive component could combat human papillomavirus (HPV)-16-infected SiHa cervical cancer cells since it is globally acclaimed for HPV-mediated warts.@*METHODS@#Thuja MT was studied for its antiproliferative and antimigratory properties in SiHa cells followed by microscopic determination of reactive oxygen species (ROS) generation by 2',7'-dichlorodihydrofluorescein diacetate (DCFDA) staining and loss in mitochondrial membrane potential (MtMP) by rhodamine 123 (Rh123) staining. Apoptosis and autophagy inductions were studied by acridine orange/ethidium bromide (AO/EB) staining and immunoblot analyses of marker proteins. The bioactive component of Thuja MT detected by gas chromatography-mass spectrometry was studied for antiproliferative and antimigratory properties along with in silico prediction of its cellular targets by molecular docking and oral drug forming competency.@*RESULTS@#Thuja MT showed significant antiproliferative and antimigratory potential in SiHa cells at a 50% inhibitory concentration (IC50) of 17.3 µL/mL. An increase in DCFDA fluorescence and loss in Rh123 fluorescence prove that Thuja MT acted through the burst of ROS and loss in MtMP respectively. AO/EB-stained cells under the microscope and immunoblot analyses supported Thuja-induced cellular demise via dual pathways-apoptosis and autophagy. Immunoblots showed cleavage of caspase-3 and poly(adenosine diphosphate-ribose) polymerase-1 (PARP-1) along with upregulation of Beclin-1, microtubule-associated protein 1 light chain 3B (LC3B)-II, and p62 proteins. Hence, the apoptotic cascade followed a caspase-3-dependent pathway supported by PARP-1 cleavage, while autophagic death was Beclin-1-dependent and mediated by accumulation of LC3BII and p62 proteins. Thujone, detected as the bioactive principle of Thuja MT, showed greater anti-proliferative and anti-migratory potential at an IC50 of 77 µg/mL, along with excellent oral drug competency with the ability for gastrointestinal absorption and blood-brain-barrier permeation with nil toxicity. Molecular docking depicted thujone with the strongest affinity for mammalian target of rapamycin, phosphoinositide 3-kinase, and protein kinase B followed by B-cell lymphoma 2, murine double minute 2 and adenosine monophosphate-activated protein kinase, which might act as upstream triggers of apoptotic-autophagic crosstalk.@*CONCLUSION@#Robust "multi-targeting" anticancer potential of Thuja drug and thujone for HPV-infected cervical cancer ascertained its therapeutic efficacy for HPV infections.
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Animals , Female , Humans , Mice , Apoptosis , Autophagy , Beclin-1/pharmacology , Bicyclic Monoterpenes , Caspase 3 , Cell Line, Tumor , Mammals/metabolism , Molecular Docking Simulation , Papillomavirus Infections/drug therapy , Phosphatidylinositol 3-Kinases , Poly(ADP-ribose) Polymerase Inhibitors/therapeutic use , Reactive Oxygen Species/metabolism , Thuja/metabolism , Uterine Cervical Neoplasms/pathologyABSTRACT
Background: Pregnancy beyond term is associated with adverse maternal and perinatal outcome. The aim of the study was to estimate the maternal and perinatal outcome in pregnancies at and beyond 41weeks of gestation. It was a prospective study of 140 patients with pregnancy beyond Methodology:41weeks fulfilling the eligibility criteria and admitted and delivered in department of obstetrics and gynaecology at a tertiary care hospital. We examined its association with following outcomes: age, parity, genetic factors, bishop's score at admission, mode of delivery, induction rate, meconium stained amniotic fluid, oligohydramnios, perinatal and neonatal morbidity, perineal tear, postpartum haemorrhage, maternal morbidity and mortality etc. Results:Out of 140 patients, majority was the age group of 21-25 years, 68 (48.6%) patients were primigravida while 72 (51.4%) patients were multigravida. Maximum patients 65% were not in labour whereas 35% were in labour. In 51 (36.4%) patients mode of delivery was caesarean section, in which most common indication being foetal distress in 25.5% followed by meconium stained amniotic fluid in 17.6%. In present study perinatal morbidity like stillbirth, RDS were 2.86% & 25.8% respectively. Maternal morbidity like PPH, tear and wound infection were 4.31%, 6.4%, 0.7% respectively. Conclusions: With Regular antenatal check-up, incidence of post term pregnancy can be decreased and labour induction should be considered at 41weeks to prevent maternal and perinatal complications.
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Lactogenesis is a complex physiology and an outcome of a successful reproductive cycle in mammalians. The purpose itself is to nourish the newborn with the nutrients necessary for its protection and growth a continuation from the in utero survival strategy. Thus, mammary development and physiology are intriguingly linked to the uterine changes that happen in a normal reproductive individual. Milk is a highly nutritious food that also favours the growth of microorganisms that can enter through the bloodstream or the discharge system. Briefly, the mastitis-induced release of inflammation mediators such as cytokines, interleukins, and prostaglandin F2? are established to be associated with infertility. Before breeding, mastitis can disrupt hormonal patterns (depression of estradiol production, delayed surge of luteinizing hormone) and delay ovulation. The issue of clinical mastitis is obvious but when subclinical mastitis persists for long the problem gets compounded. Thus, microbes get easily established in the mammary glands of buffaloes whose udder and teat anatomy, love for dirt, and swamp to wallow makes them more vulnerable exposing them to various kinds of pathogenic and opportunistic microbes. Buffaloes, by nature, have issues with silent heat, seasonal anestrus, more sensitive to direct radiation heat stress when faced with a pathological attack of infectious microbes in the milk chamber compromises their fertility.
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Background: Postmenopausal bleeding (PMB)accounts for 5% of gynecology visit. All with unexpected uterine bleeding should be evaluated for endometrial carcinoma since this potentially lethal disease is the cause of bleeding in approximately 10 percent patients (range 1 to 25 percent, depending upon risk factors). The aim of the study was to evaluate endometrial causes of postmenopausal bleeding (PMB) with it's correlation with endometrial thickness (ET)and hysteroscopy findings and endometrial tissue histopathology.Methods: A total 50 consecutive cases of PMB fulfilling the inclusion and exclusion criteria and giving informed consent were selected. Each patient was subjected to transvaginal sonography (TVS) in which uterus, adnexa and endometrial thickness (ET) was assessed. Then hysteroscopy and/or dilation and curettage was scheduled at subsequent visit. Endometrial sample was sent for histopathological examination. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy was calculated for ET by TVS and hysteroscopy findings, considering histopathological diagnosis as the gold standard.Results: Most common endometrial cause of PMB was atrophic endometrium (44%). The other causes were endometrial carcinoma (18%), endometrial hyperplasia (18%), endometrial polyp (12%), endometritis (4%), and leiomyoma (4%). The diagnostic accuracy of ET by TVS at a cut-off point of 5 mm was 94% with sensitivity 89.3%, specificity 100%, PPV 100% and NPV 88%. The diagnostic accuracy of hysteroscopy was 98% with sensitivity 96.4%, specificity 100%, PPV 100% and NPV 95.7%.Conclusions: Being relatively cheap, easily accessible, non-invasive, TVS with ET measurement should first line investigation in the evaluation of women with postmenopausal bleeding with suspected endometrial pathology. Although hysteroscopy is more specific and sensitive, in poor resource settings it should be limited to cases with ill-defined endometrial lining, recurrent/ persistent bleeding and cases with endometrial thickness greater than 5 mm irrespective of endometrial echotexture.
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Background: The objective of the current study was to evaluate the efficacy of preoperative betadine vaginal toileting in reducing post caesarean infections (endometritis, febrile illness, wound sepsis).Methods: This prospective longitudinal study was conducted at Maulana Azad Medical College, New Delhi over 3 months among 200 women who underwent caesarean delivery. Inclusion criteria were defined as women undergoing caesarean section. Exclusion criteria included placenta previa, active genital herpes, cord prolapse, chorioamnionitis, allergy to iodine. After taking informed consent, subjects were divided into two groups by simple randomization method using computer generated random numbers- Group 1 (case) - subjects who underwent 5% povidone iodine sponge stick cleansing in all the fornices and walls of vagina for 30 seconds after foley’s catheter insertion and before abdominal scrubbing. Group 2 (control) - subjects who didn't receive betadine vaginal toileting before caesarean section Subjects were followed for 10 days postpartum (or till suture removal/ discharge from hospital, whichever was late). Demographic data, operative details and postoperative parameters were compared between the two groups.Results: Both groups were matched for baseline patients’ characteristics (age, BMI, gestational age, operative time). Women who received preoperative betadine vaginal toileting had markedly less incidence of endometritis (case-3%, control-10%, p<0.05), overall postoperative morbidity (case-13%, control-33%, p<0.001). Incidence of postoperative febrile illness (case-6%, control-12%, p>0.05) and wound sepsis (case-5%, control-12%, p>0.05) were found to be less but not significant between both groups.Conclusions: Preoperative vaginal cleansing helps in reducing postoperative morbidity by decreasing incidence of postoperative infection.
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Cannabis indica and C. sativa have been used in homeopathy in extreme dilutions, called potencies, for therapeutic purposes since 1841. The purpose of the present study is to see whether Cannabis dilutions have specific levels of free water molecules which characterize other homeopathic potencies. The second objective is to see whether Cannabis mother tincture (MT) and potencies act on the binding sites of a protein. The three potencies 8, 14 and 32 cH were prepared from Cannabis mother tincture (MT) by successive dilution followed by succussion in 8, 14 and 32 steps, respectively. The 3 potencies of diluent medium 90% EtOH were similarly prepared. Each potency was analysed by differential scanning calorimetry (DSC) to determine the free water level in it. The drug potencies and unpotentised EtOH were tested for their binding reaction with a protein human serum albumin (HSA) by isothermal calorimetry (ITC). MTs and the potencies differ from each other and also from water control and EtOH with respect to free water content as revealed by DSC. MTs, their potencies and EtOH bind to HSA showing difference in thermodynamic parameters in terms of stoichiometry, binding constant, change in enthalpy, entropy and Gibbs free energy. Potencies may initiate their individual effect through binding with a protein thereby leading to subsequent biochemical events inside the cell.
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Plant based biofilters associated with microorganisms have been gaining popularity in controlling odorous compounds like volatile organic compounds (VOCs) as they are cost effective and an environment friendly alternative to conventional air pollution control techniques. In this context, here, we tried to evaluate the performance of potted plants based Claire’s biofilter for biodegradation of benzene. A sealed perspex chamber with lid and fan was designed to ensure minimum leakage, proper aeration and distribution of benzene inside the chamber. Five different ornamental indoor plants were placed inside the chamber sequentially and exposed to a concentration of 5 ppm benzene for 30 h each. The leakage of benzene was checked beforehand. Epipremnum aureum (Money plant) showed maximum benzene degradation in the aforementioned time period with a removal efficiency of 98%. The µmax and Ks values for 100 ppm concentration of benzene were calculated to be 0.284 h-1 and 0.427 g/m3, respectively.
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Background: Inguinal hernia repair is one of the common surgeries performed in general population under spinal anesthesia. Though Spinal anesthesia is relatively safe it has a short duration of action and can’t be used when the surgery is expected to be prolonged. To overcome this drawback various adjuvants are being increasingly used. Spinal anesthesia with 0.5% hyperbaric Bupivacaine, along with adjuvants, is routinely administered for lower abdominal surgeries. Intrathecal Nalbuphine added to Bupivacaine (0.5% Hyperbaric) has the potential to provide good intraoperative analgesia & prolongs early post-operative analgesia. Methods: 30 ASA I and II patients of age group 20-65 years, scheduled for inguinal hernia repair were included in this study on the basis of a predefined inclusion and exclusion criteria. Patients were randomized in two equal groups of 30 each. Group I patients received bupivacaine 0.5% heavy 3.1 ml + intrathecal nalbuphine 0.4 ml (0.4mg) whereas patients in group II received bupivacaine 0.5% heavy 3.1ml + 0.4ml NS. Onset of sensory and motor blockade, duration of analgesia, need for rescue analgesia, hemodynamic parameters and incidence of adverse effects was compared in both the groups. P value less than 0.05 was taken as statistically significant. Results: Demographic parameters such as gender, height, weight and BMI were found to be comparable in both the groups. Moreover, ASA grades, duration of surgery, Time of onset of sensory and motor blocks were also found to be comparable. Duration of sensory and motor block and duration of postoperative analgesia was found to be significantly more in group I as compared to group II. Hemodynamic parameters and incidence of side effects was found to be comparable in both the groups. Conclusion: Addition of nalbuphine to Bupivacaine in patients undergoing inguinal hernia repair under spinal anesthesia is associated with prolonged duration of sensory and motor blockade as well as reduced need for giving rescue analgesia without increase in incidence of side effects.
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Background: Thrombocytopenia is second most common hematological abnormality in pregnancy after anemia (Incidence 8-10%). The aim of this study is to observe the obstetric and neonatal outcomes of pregnancies complicated with thrombocytopenia and to compare its maternal and fetal outcomes.Methods: The prospective observational study was conducted at tertiary care institute over period of one and half year and 100 cases of thrombocytopenia in present pregnancy were included after fulfilling inclusion and exclusion criteria and obtaining written informed valid consent. Complete history, physical examination and relevant investigations of the patient were documented. Patients were followed up to delivery and outcomes (obstetric, maternal, fetal, neonatal) were studied. The data obtained for all the patients was analyzed with SPSS (SPSS Inc, Chicago) software packages. Statistical comparisons were performed with Pearson’s Chi- square where appropriate with p-value of <0.05 considered statistically significant.Results: Most common cause of thrombocytopenia in pregnancy was gestational thrombocytopenia in (25%) cases followed by preeclampsia (20%). Most cases (94%) were diagnosed in antepartum period out of which most (58%) at >37 weeks of gestation. Most (53%) had moderate thrombocytopenia. Incidence of maternal complications was statically significant (P-value 0.038) with most common complication being caesarian section site oozing (9%) followed by placental abruption (4%). There was no statistical significance in degree of thrombocytopenia and need for blood and blood product transfusion (P-value 0.67). Only (2%) neonates of thrombocytopenic mothers had thrombocytopenia and both required treatment.Conclusions: Most common cause of thrombocytopenia in pregnancy was gestational thrombocytopenia with uneventful pregnancy and perinatal outcomes. Few severe cases associated with medical or systematic causes leads to serious catastrophic events which can be avoided by increasing antenatal surveillance and appropriate management by multidisciplinary team of obstetrician, hematologist, anesthesiologist, neonatologist and physician.