Correlation of Venous to Arterial Carbon Dioxide Partial Pressure Difference with other Cardiac Output Indices in Patients Undergoing Intracardiac Repair for Tetralogy of Fallot

Background: Clearance of tissue carbon dioxide by circulation is measured by venous to arterial carbon dioxide partial pressure difference (AVCO2 ) and is correlated with cardiac output (CO) in critically ill adult patients. This study aimed to correlate AVCO2 with other CO indices like arteriovenous oxygen saturation difference (AVO2 ), central venous oxygen saturation (ScVO2 ), and serum lactate in pediatric patients undergoing intracardiac repair (ICR) for tetralogy of Fallot (TOF). Methods: We conducted a prospective observational study in 50 patients, of age 5months to 5 years, undergoing ICR for TOF and analyzed AVO2 , AVCO2 , ScVO2 , and lactate from arterial and venous blood gas pairs obtained at different time intervals from admission to pediatric intensive care unit(PICU)(T0 ), at 6 h (T1 ), 12 h (T2 ), 24 h (T3 ), and 48 h (T4 ) postoperatively. Bivariate correlations were analyzed using Pearson for parametric variables. Results: Admission AVCO2 was not correlated with AVO2 (R2 = 0.166, P = 0.246), ScVO2 (R2 = ?2.2, P = 0.124), and lactate (R2 = ?0.07, P = 0.624). At T1 , AVCO2 was correlated with AVO2 (R2 = 0.283, P = 0.0464) but not with ScVO2 (R2 = ? 0.25, P = 0.079) and lactate (R2 = ?0.07, P = 0.623). At T2 , T3 and T4 , AVCO2 was correlated with AVO2 (R2 = 0.338,0.440 & 0.318, P = 0.0162, 0.0013, and 0.024), ScVO2 (R2 = ? 0.344, ? 0.488, and ?0.366; P = 0.0143, <0.0001, and 0.017), and lactate (R2 = 0.305, 0.467 and 0.607; P = 0.0314, 0.00062 and <0.0001). AVCO2 was negatively correlated with ScVO2 . No correlation observed between admission AVCO2 and mechanical ventilation duration. Two nonsurvivors had higher value of admission AVCO2 compared to survivors. Conclusion: AVCO2 is correlated with other CO surrogates like AVO2 , ScVO2 , and lactate in pediatric patients undergoing ICR for TOF.

Hoof beats could mean zebras: A rare late metastasis of breast carcinoma in the rectum

Breast cancer metastasis is most commonly observed in bone, lung, liver, and brain and is rarely observed in the gastrointestinal tract (GI). In rarer cases, GI metastasis reaches the rectum and generally presents as late metastasis. The type of breast cancer usually associated with GI metastasis is invasive lobular carcinoma; however, few case reports also show their association with invasive ductal carcinoma (IDC). Here, we report a case that unfortunately is a coalescence of all these atypical events, with metastatic rectal linitis plastica (RLP) of the breast, 15 years after the treatment of the primary tumor, originating from IDC. This is the first case report from India, reporting the late metastatic presentation of breast cancer as RLP. The report emphasizes the need to correlate persistent GI symptoms to breast cancer history; however, late the presentation may be.

Comparative Assessment of E-cadherin's Expression between the Metastatic and Non-metastatic Oral Squamous Cell Carcinoma: An Immunohistochemical Study

ABSTRACT Objective: To identify the clinicopathological correlation of E-cadherin expression in metastatic and non-metastatic oral squamous cell carcinoma (OSCC). Material and Methods: A total of 90 paraffin-embedded tissue sections of OSCC were retrieved from the registry. The total selected samples were 45 cases each from the primary lesions of metastatic and non-metastatic OSCC. One section was subjected to routine Hematoxylin and eosin stain and another to immunohistochemical analysis for E-cadherin expression. Results: A non-significant (p˃0.05) increased expression is seen in the non-metastatic group compared to the metastatic group, with predominantly membrane as the staining site in either group. However, the expression of E-cadherin did not reveal any statistically significant association with independent variables such as age, gender, and adverse habits of the patients (p>0.05). On the other hand, with respect to the histological differentiation of OSCC, a significant association (p<0.001) was observed with the well-differentiated type of metastatic OSCC. Conclusion: E-cadherin was useful to some extent in predicting regional metastasis. However, further studies using a panel of biomarkers with increased sample size may help us understand the process involved in metastasis.

Role of Yoga in Health and Disease: A Conceptual Review

The Sanskrit root of the term "yoga" is derived from "yuj," which means to, yoke, to unite, and to focus and direct one's attention. Yoga is a type of mind-body exercise that combines physical movement with a conscious emphasis on awareness of one's own breath, energy, and self. The second principle is that every individual is unique and every individual has different needs. Each person therefore has to have a practise that is adapted to their individual needs. The third principle involves the learner in the healing process by actively participating in their quest for health; healing occurs from within rather than from the outside. The individual's character and state of mind are crucial to healing, according to the fourth principle healing happens more quickly when someone is in a positive frame of mind whereas if someone is in a negative frame of mind, healing could take longer. To enhance quality of life, many people practise yoga as a supplemental therapy in addition to traditional medical therapies by holding a pose for a long period of time develops strength. Slow, deep breathing and movement warm up the muscles which will help to improve the health and wellness. Yoga has shown some encouraging outcomes as a complementary therapy for depression. Thus it has a number of potential advantages in all dimensions of health and disease

Weeds infesting Wheat crop in Rohtak, Haryana

Multiple field visits were performed to investigate weed flora of wheat fields in Rohtak district of Haryana, conducted during 2018 which revealed infestation of 28 weed species comprising 15 families of grasses and broadleaf weeds. The weeds were identified with the help of available literature and through comparison with the already identified weed species. Poa annua, Polypogon monspeliensis and broadleaf weeds Chenopodium album, Rumex retroflex, Coronopus didymus were the pre-dominant weeds in moist region, whereas Cynodon dactylon, Fumaria parviflora, Chenopodium album, Polypogon monspeliensis in light soil with low salinity. There was a greater variety of weeds in Bohar and Kharawar villages and the least was found in village Sheria and Garnavati from vegetative to fully grown stage. Maximum number of species were of family Poaceae and Asteraceae. This study will be helpful as an additional tool in maintaining the floristic composition of District Rohtak as well as in controlling the weed problem

Impact of the COVID-19 pandemic on the trends in corneal donor mortality data from Eye Bank records in India

Purpose: To describe the causes and trends of corneal donor mortality from eye bank data in India during the coronavirus disease 2019 (COVID?19) pandemic. Methods: This retrospective eye bank?based study included 13,529 donors who donated their cornea between January 2018 and December 2021. Donors in whom the cause of mortality was documented were included as cases. The data were collected from the eye bank records. Results: Overall, 13,529 corneal donors were included in the study. Most of the donors were males (69.71%). The mean age of the donors was 51.55 ± 20.54 years, whereas the median age was 51 (inter?quartile range: 35–68) years. The mean age of males (49.3 ± 19.47 years) was lesser than the mean age of females (56.72 ± 21.94 years) at the time of donation. The most common age group at the time of donation was during the sixth decade of life with 2,139 (15.81%) donors. The mean age of the donors decreased by a decade from 54.95 ± 20.51 years in 2018 to 44.35 ± 18.88 years in 2021. The most common cause of donor mortality was cardio?respiratory arrest in 5,190 (38.36%) donors and trauma in 3,469 (25.64%) donors, followed by suicide in 2,790 (20.62%) donors. The trend of cardio?respiratory arrest decreased from 53.01% to 9.5% (p = <0.00001), whereas the trends of trauma increased from 21.93% to 36% (p = <0.00001) and suicide increased from 12.71% to 36.41% (p = <0.00001) between 2018 and 2021. Conclusion: Corneal donors are more commonly males in their sixth decade of life. The most common cause of donor mortality was related to cardio?respiratory arrest with a concerning rising trend in suicide cases over the years seen significantly during the pandemic

Assessment of zinc inadequacy among tribal adolescent population of central India - A cross-sectional study

Background & objectives: Zinc is a crucial micronutrient in adolescence, required for promoting growth and sexual maturation. Adolescents of some tribes may be at high risk of zinc deficiency due to dietary inadequacy and poor bioavailability of zinc from plant-based diets. This study aimed to evaluate the risk of zinc deficiency by estimating prevalence of inadequate zinc intake, prevalence of low serum zinc and stunting among tribal adolescents. Methods: A cross-sectional community-based survey was conducted among adolescents (10-19 yr) in three purposively selected districts where Bhil, Korku and Gond tribes were in majority. Structured data collection instrument comprising information about sociodemographic characteristics and dietary recall data was used. Anthropometric assessment was conducted by standardized weighing scales and anthropometry tapes, and blood sample was collected from antecubital vein into trace element-free vacutainers. Serum zinc was estimated using an atomic absorption spectrophotometer. Results: A total of 2310 households were approached for participation in the study, of which 2224 households having 5151 adolescents participated. Out of these enlisted adolescents, 4673 responded to dietary recall (90.7% response rate). Anthropometry of 2437 participants was carried out, and serum zinc was analyzed in 844 adolescents. The overall prevalence of dietary zinc inadequacy was 42.6 per cent [95% confidence interval (CI) 41.2 to 44.1] with reference to the estimated average requirement suggested by International Zinc Nutrition Consultative Group (IZiNCG) and 64.8 per cent (95% CI 63.4 to 66.2) with Indian Council of Medical Research-recommended requirements. Stunting was observed in 29 per cent (95% CI 27.2 to 30.8) participants. According to IZiNCG cut-offs, low serum zinc was detected in 57.5 per cent (95% CI 54.1 to 60.8) of adolescents, whereas it was 34.4 per cent (95% CI: 31.2-37.5) according to the national level cut-off. Interpretation & conclusions: Risk of dietary zinc inadequacy and low serum zinc concentration amongst adolescents of the Gond, Bhil and Korku tribes is a public health concern.

Enablers & challenges of tribal women & health system for implementation of screening of non-communicable diseases & common cancers: A mixed-methods study in Palghar district of Maharashtra, India

Background & objectives: Non-communicable diseases (NCDs) and cancers of breast, oral cavity and cervix contribute to around 5.87 million (60%) deaths in India. Despite this, there is limited evidence on preparedness of the tribal health system in mitigating these conditions. This mixed-methods study aimed at identifying enablers and challenges using a multistakeholder approach for the screening of NCDs and common cancers in a tribal block of Maharashtra, India. Methods: This study was conducted in a tribal community of Dahanu taluka in Palghar district of Maharashtra. A total of nine focus group discussions (FGDs) among tribal women and accredited social health activists (ASHAs), 13 key informant interviews (KIIs) among auxiliary nurse midwives (ANMs) and community health officers (CHO) and facility surveys of five public health facilities were conducted. The FGDs and KIIs were conducted using guides, recorded digitally, transcribed, analyzed and triangulated to identify emerging themes. Results: The tribal women had limited knowledge about NCDs and common cancers. Paucity of health facilities, out-of-pocket expenditure, misconceptions, belief on traditional healers and inability to prioritize health were identified as major challenges. The ASHAs were recognized as a key connecting link between health system and community while provision of culturally appropriate IEC materials and adequate training were recognized as critical enablers by healthcare providers in implementing screening for NCDs and common cancers. Interpretation & conclusions: The study recommends incorporating socioculturally relevant strategies in the tribal population and strengthening health facilities in terms of infrastructure and training with involvement of ASHAs for successful implementation of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) through health and wellness centres.

Efficacy of topical tulsi (Ocimum sanctum) paste for the management of oral submucous fibrosis – A clinical study

Context: Oral submucous fibrosis (OSMF) is a chronic insidious oral potentially malignant disorder characterized by increased collagen deposition and reduced collagen degradation causing burning sensation and difficulty in mouth opening. Aim: To assess the efficacy of topical Tulsi (Ocimum sanctum) paste for the management of OSMF. Settings and Design: Institution?based clinical trial. Materials and Methods: The study included a total of 60 OSMF patients categorized into three Groups A, B and C (20 in each) depending on the severity according to Lai DR et al. classification. The patients were advised for topical Tulsi paste application and were evaluated for the reduction in the burning sensation and improvement in mouth opening every month for 3 subsequent months using the numeric pain rating scale (NRS) and a Vernier calliper, respectively. Statistical Analysis: The baseline and 3?month recordings were subjected to inter? and intra?group statistical analysis using Kruskal–Wallis analysis of variance (ANOVA), Mann–Whitney U, one?way ANOVA, Tukey’s multiple post?hoc and Wilcoxon matched?pairs tests. Results: There was a reduction in the burning sensation and improvement in the mouth opening in all three groups. The reduction in the burning sensation was statistically significant among all the groups (P < 0.05) and the NRS scores after 3 months among the three groups were not statistically significant (P > 0.05). There was a statistically significant difference (P < 0.05) in the improvement of mouth opening between Group A and B; A and C; but not between B and C. Conclusion: Tulsi paste showed a significant reduction in the burning sensation and improvement of the mouth opening thereby proving to be a safe and promising medicament for OSMF

Optical coherence tomography features and correlation of functional and structural parameters in patients of idiopathic intracranial hypertension

Purpose: To determine the correlation between functional parameters and optical coherence tomography (OCT) features in patients of idiopathic intracranial hypertension (IIH). Methods: A prospective observational study in early and established cases of papilledema in IIH presenting from December 2017 to February 2019. Functional parameters (visual acuity, contrast sensitivity, mean deviation, VER, and MfERG) and structural parameters (RNFL, GCL?IPL, and optic disc height) were measured at baseline and every 6 weeks for 6 months. Results: At baseline, average RNFL had a moderate negative correlation with mean deviation (r = ?0.45; P = 0.0007) and a positive correlation with logMAR visual acuity (r = 0.18; P = 0.17). On the contrary, baseline GCL and logMAR visual acuity had a negative correlation (r = ?0.4, P = 0.02). Optic disc height (ODH) had a negative correlation with visual field mean deviation (r = ?0.046; P = 0.0005). At 6 months, ODH and GCL?IPL complex had a statistically significant correlation with functional parameters. However, RNFL values did not show any significant correlation with any of the functional parameters. Baseline GCL?IPL and optic disc height values had a moderate and significant correlation with final functional parameters. However, RNFL did not show any correlation with final functional parameters. Correlation between GCL?IPL thickness at 6 weeks and final functional parameters were stronger than that with baseline GCL values. Conclusion: In the setting of severe papilledema, RNFL can misguide the prognosis. GCL?IPL can be a valuable tool for an objective evaluation of the integrity of the optic nerve in IIH and ODH may be used as an alternative or in combination with GCL?IPL in these cases.

Comparative studies on protective efficacy of gentisic acid and 2-pyrocatechuic acid against 5-fluorouracil induced nephrotoxicity in Wistar rats

Nephrotoxicity is a frequent and severe side effect of 5-fluorouracil (5-FU) chemotherapy which limits its use clinically regardless of being one of the most promising chemotherapeutic agents. Here, we assessed the nephroprotective activity of two structurally related phenolic acids 2-pyrocatechuic acid (2,3 dihyroxybenzoic acid) and gentisic acid (2,5 dihyroxybenzoic acid) against 5-FU induced nephrotoxicity in Wistar rats. Intraperitoneal administration of 5-FU at a dose of 20 mg/kg once a day for 5 days produced a significant elevation in serum parameters of the kidney such as uric acid, urea, creatinine, sodium and potassium levels along with severe histopathological changes in renal tissues of rats indicating severe nephrotoxicity. Administration of 2-pyrocatechuic acid (2-PCA) at 10, 30 and 100 by oral route for 9 days and additional 5 days with 5-FU resulted in an amelioration of altered serum parameters in a dose-dependent manner. Moreover, 2-PCA attenuated the renal damage produced by 5-FU demonstrating its efficacy as a nephroprotective agent for the prevention as well as amelioration of 5-FU induced nephrotoxicity. None of the doses of gentisic acid (GA) were found to be effective in this posology when given orally.

Role of Bala Taila Nasya and Rasnadi Guggulu in Karnasrava (Chronic Suppurative Otitis Media)

In Ayurveda, Karnasrava is mentioned as Vata Pradhan Tridoshaja and Sadhya Vyadhi in Shalakya Tantra. The term Karnasrava is self explainatory itself, which means Srava (discharge) from Karna (ear). For this study 30 patients were registered from OPD/IPD of Gurukul Campus, Haridwar; who were clinically diagnosed patients of Karnasrava/CSOM. There was only one group, so combined effect of Bala Taila Nasya and Rasnadi Guggulu was seen in patients. Results of the study indicates that highly significant result was seen in earache, Karnasrava (quantity of discharge), tenderness over mastoid antrum and consistency of discharge. Not significant result was seen in degree of hearing loss while in T.M. perforation size result was only significant.

Indian Academy of Pediatrics (IAP) Task Force Recommendations for Incorporating Nurturing Care for Early Childhood Development (NC-ECD) in Medical Education in India

Background: The World Health Organization (WHO) recommends promotion of nurturing care for early childhood development (NCECD) by focusing on five essential components viz., good health, adequate nutrition, promotion of early childhood learning, responsive caregiving, and safety and security. Indian medical graduates and pediatricians are the keys to successful delivery and propagation of NC-ECD in the community. Their training therefore needs to include skills and knowledge needed to promote and practice ECD. Objective: To evaluate the existing undergraduate (UG) and postgraduate (PG) curricula of pediatrics for components related to early childhood development, assess gaps in the training essential to practice and promote ECD, and suggest recommendations to incorporate NC-ECD in the UG and PG curricula. Process: Indian Academy of Pediatrics created a task force to review the UG/PG medical curricula, consisting of experts from pediatrics and medical education. The task force deliberated on 20 March, 2021 and identified the gaps in current curricula and provided suggestions to strengthen it. The recommendations of the task force are presented here. Recommendations: Taskforce identified that the UG/PG medical curricula are lacking training for propagating early childhood learning, responsive caregiving, caregiver support, and ensuring safety and security of children. The taskforce provided a list of competencies related to ECD that need to be included in both UG and PG curriculum. NC-ECD should also be included in topics for integrated teaching. Postgraduates also need to be exposed to hands-on-training at anganwadis, creches, and in domestic setting.

Comparison of Time Taken for Feeding Stable Preterm Babies Between Regular Nurse Feeding and Feeding with Feed Rail—A Randomized, Controlled Study

Objective To compare the variation of feeding rate and time taken for feeds between manual and automated feeding via feed rail. Methods Stable preterm babies weighing between 1 and 2 kg, on partial or full enteral feeds via gavage were randomized into gravity and feed rail feeding group, respectively. Ten nurses and 4 babies were paired to form 40 nurse-baby pairs for the study. Forty feeding events in each groups were recorded. Results The median duration of feeding in the feed rail group was 18.5 min compared to 15 min in nurse-led feeding (p = 0.34). Feeding rate corrected for bodyweight ranged between 0.8 and 2.3 mL/kg/min in the feed rail group compared to 2.5 and 8.9 mL/ kg/min in the control (manual gravity feed) group. This difference in the feed rate variation was statistically significant (p value of <0.0001). The median feed rate with feedrail was 1.3 mL/min as compared to 4.1 mL/min with manual gravity feeds. During the feed rail feeding, nurses were hands-free for 80% of the time. Conclusion Feed rail feeding results in slow, sustained, and minimal variation in gravity feeding at a rate of 1 to 2 mL/kg/min without affecting the feeding duration compared to manual nurse-led feeding.

When to Discharge a Patient After Endoscopy: A Narrative Review

Video endoscopy is an important modality for the diagnosis and treatment of various gastrointestinal diseases. Most endoscopic procedures are performed as outpatient basis, sometimes requiring sedation and deeper levels of anesthesia. Moreover, advances in endoscopic techniques have allowed invasion into the third space and the performance of technically difficult procedures that require the utmost precision. Hence, formulating strategies for the discharge of patients requiring endoscopy is clinically and legally challenging. In this review, we have discussed the various criteria and scores for the discharge of patients who have undergone endoscopic procedures with and without anesthesia.

Homoeopathy a system of holistic healing as an alternative treatment for PCOS: a review

Polycystic ovarian syndrome (PCOS) is a complex hormonal and metabolic disorder characterized by oligomenorrhea or amenorrhea, hyperandrogenism and infertility. Global prevalence of PCOS is estimated to be between 06% and 26%. Homoeopathy, being a system of holistic healing can be accepted as one of the alternative treatments for PCOS. Aim & Objective: The aim of the study is to review clinical data, where the intervention was aimed to treat PCOS through Homoeopathy. The objective of the study is to identify the therapeutic approach, assessment criteria, treatment outcomes through an alternative therapy i.e., Homoeopathy in cases of PCOS. Methods: A systematic literature search was conducted in the month of June2021 following International/National search databases for all clinical studies published in the period from 2000 to 2021. This search was aimed to target the entire literature of randomized trials or controlled trials, observational studies case studies/reports on PCOS in homoeopathy. Result:28 articles related to Homoeopathy on PCOS were identified. Out of these 28studies, 22 studies (01 RCT, 02 NRCT,06 observational studies,04 case series and 09 case reports) were included in this review. All studies were published in peer reviewed journals.Conclusions:To establish the evidence-based efficacy of the homoeopathic treatment in cases of RCT more pragmatic studies need to be planned in the future based on proper diagnostic criteria.

Impact of psychological distress due to COVID-19 pandemic on spouse interpersonal relationships

Background: The novel virus, COVID-19, has proven to be a stressor on many levels due to factors like health, economic disruptions, lockdown, and stay-at-home orders. However, one of the significant stressors has been on relationships, primarily the intimate ones, like between spouses. To investigate the correlation between psychological distress and quality of spouse interpersonal relationships. Methodology: The mixed research design (i.e., qualitative and quantitative methods) was employed on 119 participants between 22-62 years of age, followed by a semi-structural interview of 12 participants, all through virtual snowball mode due to the COVID-19 scenario. Socio-demographic profile, psychological distress scale, and the quality of spouse interpersonal relationships scale and a semi-structural interview schedule were used for data collection. Results: The present study shows that psychological distress is negatively correlated with certain aspects like conflict, criticism, resentment, pressure, dominance, relative power, and exclusion of the quality of spouse interpersonal relationships. On the other hand, a positive correlation was observed with affection, emotional support, reliable alliance, satisfaction, companionship, and approval aspects of the quality of spouse interpersonal relationships. Qualitative results shows that argument with each other, disagreement, point out faults, pressurization for intimation, and violence with partner are some of the most prominent negative effects in their present life while developed understanding to each other, sense of trust, feel good, received love and affection, care for each other, emotional support, help in other household errands, and take care of children and parents are some of the positive aspects seen instead of the psychological distress perceived during this pandemic. Conclusions: COVID-19 has had considerable effects on spousal interpersonal relationships and needs further study

Fatal sickling-associated microvascular occlusive crisis in a young with sickle cell trait

Sickle cell trait (SCT), a heterozygous state characterized by hemoglobin AS, occurs commonly in sub-Saharan Africa, South America, Central America, India, and the Mediterranean countries. SCT is compatible with a normal lifespan and is not commonly regarded as a cause of morbid illness or death compared to its homozygous counterpart. We describe a case of fatal sickling-associated microvascular crisis, identified on post mortem evaluation in a previously undiagnosed 21-year-old military recruit with sickle cell trait. The individual presented with repeated syncope episodes during his training and was autopsied in the pursuit of cardiac anomalies and heat syncope. During the terminal episode, he collapsed and died of severe metabolic complications as he struggled to complete an organized run during routine training activities. To our knowledge, this is the first report of fatal sickling-associated crisis in a military recruit with sickle cell trait from India. This case serves to remind all armed forces and sports physicians of the importance of screening a recruit who is unable to complete exertional physical training for the presence of sickle cell trait.