Learning to switch gears — Steering palliative care into emergency medicine

Emergency care is largely seen as synonymous with resuscitation and saving lives. In most of the developing world where Emergency Medicine (EM) is still evolving, the concept of EM palliative care is alien. Provision of palliative care in such settings poses its own challenges in terms of knowledge gaps, socio-cultural barriers, dismal doctor-to-patient ratio with limited time for communication with patients, and lack of established pathways to provide EM palliative care. Integrating the concept of palliative medicine is crucial for expanding the dimension of holistic, value-based, quality emergency care. However, glitches in decision-making processes, especially in high patient volume settings, may lead to inequalities in care provision, based on socio-financial disparities of patients or premature termination of challenging resuscitations. Pertinent, robust, validated screening tools and guides may assist physicians in tackling this ethical dilemma.

Intentional Replantation to Rehabilitate and Preserve the Integrity of Maxillary Central Incisor with Complicated Crown En-masse Fracture.

The present case aims to describe the management of a complicated crown en masse fracture in a maxillary central incisor due to trauma by intentional replantation as the chosen treatment modality. Intentional replantation aiming towards successful endodontic therapy comprises intentional therapeutic extraction of the tooth and an endodontic procedure in a controlled environment followed by replantation. A 24-year-old female patient presented to the department with a chief complaint of broken upper front teeth following trauma. The teeth were tender on percussion. The periapical radiographic examination revealed a complicated fracture involving the pulp without significant periapical changes. A diagnosis of Ellis Class III was established and intentional reimplantation was planned with the patients consent. Following an atraumatic extraction, conventional root canal treatment was completed. Subsequently, a fibre-post was used to reinforce the tooth structure. The tooth was placed back into the socket and splinted. One year of follow up examination revealed absence of pain and periapical healing. The treatment yielded a clinical, aesthetic and functionally satisfactory result, establishing intentional replantation to be a feasible treatment option in complicated crown en masse fracture of the tooth.

Relationship of thyroid profile with body mass index and metabolic syndrome

Background: Metabolic syndrome is known to be associated with endocrine disorders, especially the thyroid dysfunction. The resultant thyroid dysfunction in patients with metabolic syndrome may add up to the already existing burden of cardiovascular diseases. Objectives: This study was intended to assess the thyroid function in patients with metabolic syndrome and evaluate its relationship with components of metabolic syndrome. Materials and Methods: A cross-sectional study was conducted among 100 adults attending the medicine department of a teaching hospital in Tamil Nadu. Relevant clinical examination with anthropometric measurements and blood examination was done in them. Results: There were 23 (23%) patients totally with at least three components of metabolic syndrome among the study population. The incidence of metabolic syndrome in adults with overt hypothyroidism was 100% and it was 50% in subclinical hypothyroidism. Almost all the components of metabolic syndrome except high-density lipoprotein cholesterol were significantly associated with thyroid dysfunction. Values of serum thyroid-stimulating hormone and free T4 correlated with waist circumference. There was a negative correlation of triglycerides with free T3 and T4 values. Conclusion: Thyroid dysfunction, especially the hypothyroidism, is commonly associated with metabolic syndrome. Therefore, there is a need to screen patients with metabolic syndrome for thyroid dysfunctions and vice versa.

Pharmacokinetic evaluation, molecular docking and in vitro biological evaluation of 1, 3, 4-oxadiazole derivatives as potent antioxidants and STAT3 inhibitors / 药物分析学报

1, 3, 4-Oxadiazole derivatives (4a–5f) were previously synthesized to investigate their anticancer properties. However, studies relating to their antioxidant potential and signal transducer and activator of transcription (STAT) inhibition have not been performed. We investigated previously synthesized 1, 3, 4-oxadiazole de-rivatives (4a–5f) for various radical scavenging properties using several in vitro antioxidant assays and also for direct inhibition of STAT3 through molecular docking. The data obtained from various antioxidant assays such as 2, 2,-diphenyl-1-picrylhydrazyl radical (DPPH), nitric oxide, hydrogen peroxide, and superoxide anion radical revealed that among al the derivatives, compound 5e displayed high antioxidant activities than the standard antioxidant L-ascorbic acid. Additionally, the total reduction assay and antioxidant capacity assay further confirmed the antioxidant potential of compound 5e. Furthermore, the molecular docking studies performed for all derivatives along with the standard inhibitor STX-0119 showed that binding energy re-leased in direct binding with the SH2 domain of STAT3 was the highest for compound 5e (-9.91kcal/mol). Through virtual screening, compound 5e was found to exhibit optimum competency in inhibiting STAT3 activity. Compound 5e decreased the activation of STAT3 as observed with Western blot. In brief, compound 5e was identified as a potent antioxidant agent and STAT3 inhibitor and effective agent for cancer treatment.

Sequential Bilateral Torsion of a Normal Ovary at 31 Weeks of Gestation and 12 Months Following Delivery.

Torsion of a normal ovary should be considered in the differential diagnosis of acute abdominal pain in the third trimester. Accurate diagnosis and early surgical intervention is essential to avoid fetal and maternal morbidity and mortality. We herein report a case of torsion of a normal ovary alone at 31 weeks of gestation following a spontaneous conception and again torsion of right normal ovary 14 months later. We had to do oophorectomy in both instances since the ovaries were gangrenous.

Postoperative infection of laparoscopic surgery wound due to Mycobacterium chelonae.

We report a case of postoperative wound infection due to Mycobacterium chelonae. A 35-year-old woman presented with multiple erythematous nodules, plaques and discharging sinuses over the abdomen, 45 days after she had undergone laparoscopic ovarian cystectomy. The seropurulent discharge from the wound showed acid-fast bacilli on Ziehl- Neelsen stain and culture yielded Mycobacterium chelonae. The patient responded to clarithromycin and doxycycline. The source of infection was probably contaminated water or disinfectant solution used for sterilization of laparoscopic instruments.

Precocious pseudopuberty with testicular enlargement.

Gonadotropins independent precocious puberty (GIPP) in male is characterized by early appearance of sexual hairs and phallic growth but without testicular enlargement. We report a case of GIPP with testicular enlargement who was diagnosed to have testotoxicosis and successfully managed with spironolactone.

Mycotoxins in foods--occurrence, health & economic significance & food control measures.

Mycotoxins of importance in India include aflatoxin, fumonisins, trichothecenes, ergot alkaloids and ochratoxins. The ICMR multicentric study on the occurrence of aflatoxin contamination in risk commodities namely, maize and groundnut showed that 21 per cent of groundnut samples and 26 per cent of maize samples analysed exceeded Indian tolerance limits of 30 micrograms/kg. A study on the aflatoxin intake from maize-based diets in a rural region of Andhra Pradesh showed the intakes to be in the range of 4-100 ng/kg body wt/day. Studies on the occurrence of aflatoxin M1 in milk in the southern and western regions of India indicated levels in the range of 0.05-3.0 micrograms/l. Analysis of feed samples indicated high incidence of aflatoxin B1 contamination in the groundnut cake component. Fumonisins have been shown to occur in Indian maize and sorghum. Studies showed high levels of fumonisins in rain-affected maize and sorghum consumption of which resulted in an outbreak of fumonisin mycotoxicosis in rural regions of the Deccan Plateau. A similar disease outbreak occurred in poultry due to consumption of fumonisin contaminated feed containing rain damaged maize. Biomarkers have been developed for assessing the risk of exposure for two mycotoxins viz., aflatoxin by measurement by ELISA of aflatoxin B1 N7-guanine adduct which has a detection limit of 15.6 pmol aflatoxin B1 N7 guanine; and fumonisin B1 by measurement in urine using HPLC with a detection limit of 8 ng/ml urine. Assessment of the economic implications of aflatoxin contamination showed economic losses resulting in rejection of export consignment of hand-picked-selected (HPS) groundnut and losses in the poultry industry. Approaches for prevention and control of mycotoxin contamination in foods have shown that methods involving the segregation of contaminated or mouldy grains by hand picking and density segregation resulted in a reduction of 70-90 per cent of aflatoxin and fumonisin present in the grains. While harmonization of international regulatory limits, the requirements of food producing countries needs to be recognized and realistic but not idealistic safe limits, need to be proposed.

Parasitic contamination of stored water used for drinking/cooking in Hyderabad.

A study was undertaken to investigate the parasitic contamination of water in Hyderabad city, India. A total of 232 samples of water were collected from different places; social welfare hostels, small restaurants, different households, public places like railway stations, bus depots, street food vendors, hand washings from the food handlers, and vegetable washings from vegetable vendors. Of these 232 samples 61 samples indicated the presence of pathogenic parasites which include protozoans (cysts of Giardia lamblia, Entamoeba histolytica, adult stages of G. lamblia, Balantidium coli) and nematode eggs, (Enterobius vermicularis, Ascaris lumbricoides, Trichuris trichiura), rhabditiform and filariform larvae and adult stages of Strongyloides stercoralis and Enterobius vermicularis. The source of the samples in all places was the water stored in overhead tanks and various other containers. Hand washings from food handlers also showed the presence of pathogenic parasites although the original water used for such washings were free from contamination.