Achromobacter Spp.: A retrospective review of rare and emerging pathogen

Background: Achromobacter spp. is a rare nosocomial pathogen known to cause many serious infections like bloodstream infection, osteomyelitis, meningitis, urinary tract infections, corneal ulceration, peritonitis, and endocarditis. Materials and Methods: In this study, we retrospectively analyzed all the bacteriological sample records from the bacteriology database from January 2021 to December 2021 to determine the prevalence of Achromobacter spp. Result: Nine patients with Achromobacter xylosoxidans causing bacterial infection were identified, from whom five blood samples, two pus, one respiratory sample, one central venous pressure (CVP), and one cerebrospinal fluid were found positive for Achromobacter spp., among whom one was a 6-year-old patient having the same organism from two different body sites—CVP line and cerebrospinal fluid. Five patients had coinfection with another organism, whereas acute kidney injury was the most common comorbidity. Conclusion: In our single-center experience, approximately 50% of the cases with Achromobacter denitrificans bacteremia suffered from chronic kidney disease and had a history of antibiotic therapy, hospitalization, and the presence of devices. Active research on rising trends of Achromobacter spp. needs to be promoted.

Bioactivity evaluation of least explored traditionally acclaimed medicinally potent herb Nanorrhinum ramosissimum(Wall. ) Betsche

Abstract Present study analysed the therapeutic potential of traditionally acclaimed medicinal herb Nanorrhinum ramosissimum, using plant parts extracted with different solvents (10 mg/mL). Shoot extracts exhibited comparatively better antimicrobial properties, in comparison to root extracts. Total phenolic content was estimated, to ascertain its dependency on antioxidant properties of plant extracts. Antioxidant assay revealed promising results in comparison to IC50 value of standard ascorbic acid (52.2±0.07 µg/mL), for methanolic extracts of shoot (61.07±0.53 µg/mL and 64.33±0.33 µg/mL) and root (76.705±0.12 µg/mL and 89.73±0.28 µg/ mL) for in vivo and in vitro regenerants respectively. Correlation coefficient R2 values ranged between 0.90-0.95, indicating a positive correlation between phenolic contents and antioxidant activity. Plant extracts were also able to inhibit DNA oxidative damage again indicating their antioxidative potential. Antidiabetic potential was confirmed by alpha amylase inhibition assay where shoot methanolic extracts (invivo, in vitro) exhibited the best IC50 values (54.42±0.16 µg/mL, 66.09±0.12 µg/mL) in comparison to standard metformin (41.92±0.08 µg/mL). Ethanolic extracts of roots (in vitro, invivo) exhibited the relative IC50 values (88.97±0.32µg/mL,96.63±0.44 µg/mL) indicating that shoot parts had a better alpha amylase inhibition property; thus proving the herb's bioactive potential and its prospective therapeutic source for curing various ailments.

Ayurvedic Management of Artavakshaya w.s.r. to Polycystic Ovarian Syndrome: A Case Report

Normal menstrual cycle is a crucial physiological phenomenon for maintaining woman’s health during reproductive years. Nowadays, menstrual disarrayed are the main reasons for gynecological consultations worldwide owed to faulty dietary habits and lifestyle. Oligomenorrhea is one among all menstrual disorders with a prevalence of 13.5% in general population and is characterized by irregular, inconsistent menstrual blood flow. In Ayurveda it can be correlated with Artavakshaya due to their strong symptom equality. Prevalence of Artavakshaya is rising in present gynecological practice which may leads to terrifying sequel of infertility. In modern science, only hormonal preparations are used as treatment strategies but only offer short term symptomatic management. Methodology: A female patient of 17 years of age came to OPD of National Institute of Ayurveda, Jaipur, on 29/01/2022 with chief complaints of irregular (delayed) menses with prolonged interval of 4-5 months since last 1 year along with USG findings of Bilateral Polycystic Ovarian Disease with simple Ovarian cyst in left Ovary. In this case study, patient was treated with some oral Ayurvedic preparation for 2 consecutive cycles having Strotoshodhak, Kapha- Vatashamak, and Vataanulomaka properties. Result: Patient had her menstruation regularly with normal duration during and after treatment.

Risk Factors of Delirium in Children in Pediatric Intensive Care Unit

Objectives: To determine the prevalence of delirium and its risk factors among children admitted to a Pediatric intensive care unit (PICU). Method: A descriptive study in which consecutive patients admitted to the PICU over a period of 12 months were screened daily for delirium using the Cornell Assessment of Pediatric Delirium (CAPD) score. Treatmentrelated and demographic variables were collected and analyzed. The statistically significant risk factors for delirium were analyzed by multivariable logistic regression for independent associations. Results: Among the 476 screened patients, 96 (20.2%) developed delirium. The independent risk factors associated with the development of delirium were respiratory failure (P<0.001), administration of benzodiazepines during PICU stay (P<0.001), and presence of multiple (?2) risk factors for delirium (P<0.001). The mean length of PICU stay was significantly higher among delirious subjects with P<0.001. Conclusion: Delirium is a frequent complication in critically ill children, and recognition of associated factors may assist in early diagnosis and focussed management.

Efficacy of port-site infiltration with ropivacaine alone versus ropivacaine with fentanyl for postoperative analgesia in patients undergoing laparoscopic procedures

Background and aims: Wound infiltration as a pre-emptive measure to relieve post-operative pain is a common practice following laparoscopic procedures. The addition of adjuvants like opioids to local anesthetics can facilitate the prolongation of postoperative analgesia. Our primary aim was to compare the analgesic efficacy of peri-portal infiltration of Ropivacaine alone versus Ropivacaine with Fentanyl in patients undergoing laparoscopic operations. Methods: The study was conducted on 80 ASA physical status I and II patients, aged 18 to 65 years, undergoing surgical procedures under general anesthesia. Group R was infiltrated with Ropivacaine (0.5%) (18ml+2ml saline) while in Group RF, Ropivacaine(18ml) with Fentanyl 2ml (100礸)] was infiltrated around ports, before wound closure. At the end of the surgery, one of our study drug solutions was infiltrated, to which the patient as well as the assessor were blinded. Postoperative pain was assessed by the VAS (visual analog scale) score. Injection Tramadol 100mg was given as a rescue analgesic if the VAS score was ? 3. Student抯 t-test and Fischer抯 exact test were applied for continuous and categorical variables; Kruskal Wallis and Mann Whitney U test for nonparametric data. The entire statistical analysis was done using STATA 13[ STATA CORP. TEXAS, USA] software. Results: The mean duration of analgesia was significantly longer in group RF, with a requirement of fewer doses of rescue analgesics, compared to group R. Conclusion: The addition of Fentanyl to Ropivacaine for periportal infiltration was found to be superior to Ropivacaine alone in providing effective postoperative analgesia as well as reducing the requirement of rescue analgesics.

Clinical and Genetic Profile of Children With Short Stature Presenting to a Genetic Clinic in Northern India

Objective: To define the spectrum of genetic disorders in patients with short stature visiting the genetic out-patient department in a tertiary care hospital. Methods: A chart review was done for 455 individuals (10 months-16 yrs) with short stature, who were evaluated at the genetic clinic from 1 January, 2017 upto 31 October, 2018. 226 patients who needed detailed evaluation, the spectrum of genetic diagnosis is presented. Results: Proportionate short stature was identified in 63% individuals (n=142) of which 93 (65%) were recognizable syndromes such as Turner syndrome, and William syndrome, and RASopathies. In clinically undefined syndromes (39, 27%), a diagnosis could be made by karyotype (n=3/10), chromosomal microarray (6/12) and exome sequencing (1/6). In the 84 children in the disproportionate short stature group (37%), lysosomal storage disorders (LSDs) (45%, n=38) were identified by enzyme analysis in 86.8% and skeletal dysplasias (44%, n=37) identified by skeletal survey in 89% cases. Conclusions: In undefined syndromic short stature, chromosomal microarray may be the first investigation of choice if phenotyping is not suggestive of a specific genetic syndrome. Exome sequencing can be useful in identifying newer genes among idiopathic and familial short stature cohorts.

A Novel Approach of Ayurveda Towards the Understanding of Shookdhanya Varga (Cereals) and Their Fundamental Characteristics and Health Benefits: A Critical Study

In order to achieve the healthy life, it is important to follow the first principal of Ayurveda which is Ahara (diet). The importance of Ahara in life is described by Acharaya charak in classical texts, where every aspect of Ahara including its regular intake, different categories has been elaborated aptly. In Charak samhita, Acharya has classified the Ahara in 12 different categories. Among these, Shookdhanya (cereals) is first one. Shashtika (rice) Vrihi (rice), Yava (barley), Godhum (wheat) are categorized under Shookdhanya (cereals). The food of these groups has similar pharmacological properties with Madhur rasa (sweet in taste), Madhur vipak (sweet after digestion) and Vata kaphahar action. According to modern science Shook dhanya dravya are included in monocotyledon and energy giving food. Energy giving food mainly includes cereal groups like wheat, rice, maize (corn), oats, Jowar, Ragi, and Bajra. Here an attempt has been made to study the fundamental characteristics and health benefits of the class of cereals (Shookadhanya group of Ahara).

The effectiveness of the two-layered closure of persistent Oroantral Fistula using Buccal Fat Pad and Buccal Advancement Flap.

Background: A prospective clinical study was conducted to assess the effectiveness of the two -layered closure of recurrent Oroantral Fistula using Buccal Fat Pad and Buccal Advancement Flap. Materials and methods: Twenty patients with persistent OAFs larger than 5 mm were treated with two layered closure using Buccal Fat Pad and Buccal Advancement Flap. They were followed clinically and radiographically for 5 years after surgery to monitor the durability and effectiveness of the two layered closure of the OAF. Result: The procedure was successful in all patients. The healing process was satisfactory,with no breakdown or liquefaction necrosis postoperatively. No complications were observed during the follow-up period. Conclusion: The results of this study support the view that the use of the double-layered closure using BFP with buccal advancement flap is a durable, convenient, and effective method for the treatment of a persistent large OAF.

Comparison of the clinical performance of the i-gelTM, LMA SupremeTM, and Ambu AuraGainTM in adult patients during general anesthesia: a prospective and randomized study / 대한마취과학회지

Background@#Supraglottic airway devices (SADs) are routinely used for securing the airway. In this study, the clinical performance of three SADs in adult patients under general anesthesia was compared. @*Methods@#American Society of Anesthesiologists physical status I-III subjects were randomly assigned to the i-gelTM (I), LMA SupremeTM (L), or Ambu AuraGainTM (A) group (30 per group). The primary objective of this study was to compare insertion times. Additionally, the ease of insertion, number of attempts, oropharyngeal leak pressure (OLP), airway maneuver requirement, difficulty with gastric tube placement, and complications were assessed. @*Results@#Demographic data did not differ between the groups. Group I (16.9 ± 4.9 s) had a significantly shorter time of insertion than Group L (19.6 ± 5.2 s) and Group A (22.1 ± 5.7 s) (P = 0.001). The OLP for Group A (29.8 ± 3.0 cmH2O) was higher than those for Group L (24.1 ± 6.3 cmH2O) and Group I (9.4 ± 6.1 cmH2O) (P < 0.001). The number of insertion attempts (P = 0.232), ease of insertion (P = 0.630), airway maneuver requirement (P = 0.585), difficulty with gastric tube placement (P = 0.364), and complications (P = 0.873) were not significantly different between the groups. @*Conclusions@#All three devices are convenient and effective for airway management in adults under general anesthesia. However, the shorter insertion time required for the i-gel may make it more suitable for resuscitation and emergencies, while aspiration risk may be reduced with the Ambu AuraGain, given its high OLP.

Ultrasound-Guided Lumbar Transforaminal Epidural Injection: A Narrative Review

Transforaminal epidural steroid injection is often administered to patients with radiculopathy under fluoroscopic guidance, although it has disadvantages of radiation hazards and requirement of a special area to perform the block. To avoid these disadvantages, ultrasound-guided transforaminal injection (USTFI) has recently been described and is continually developed. This review article describes the indexed articles published on USTFI and ultrasound-guided selective nerve block (SNRB) to evaluate current evidence on best approach to perform the block. Through literature search, eight articles and one case report on USTFI and five articles on ultrasoundguided SNRB were found. Most of the studies have utilized parasagittal orientation of curvilinear probe to perform the block. Nevertheless, with the present literature, it is difficult to come to any conclusion. Further studies with larger sample size and description of dye spread patterns are recommended to come to a more definite conclusion.

Ultrasound-Guided Lumbar Transforaminal Epidural Injection: A Narrative Review

Transforaminal epidural steroid injection is often administered to patients with radiculopathy under fluoroscopic guidance, although it has disadvantages of radiation hazards and requirement of a special area to perform the block. To avoid these disadvantages, ultrasound-guided transforaminal injection (USTFI) has recently been described and is continually developed. This review article describes the indexed articles published on USTFI and ultrasound-guided selective nerve block (SNRB) to evaluate current evidence on best approach to perform the block. Through literature search, eight articles and one case report on USTFI and five articles on ultrasoundguided SNRB were found. Most of the studies have utilized parasagittal orientation of curvilinear probe to perform the block. Nevertheless, with the present literature, it is difficult to come to any conclusion. Further studies with larger sample size and description of dye spread patterns are recommended to come to a more definite conclusion.

Abetalipoproteinemia - A Rare Disease Presenting as Bleeding Disorder

A 5-month-old child presented to the Paediatric Outpatient Department with complaints of fever, loose stools, blood in stool, and multiple subcutaneous swellings over the chest wall. The patient was given antibiotics and treated for acute gastroenteritis with a possibility of component of cow’s milk allergy also being considered. The routine blood counts revealed platelet count of 4.94 K / mL, along with Hb 10.2 g / dL, MCV - 80 fL, WBC - 13.6 x 109 / L. An LDH of 512 U / L (normal up to 451 U / L) and ESR of 2 mm / 1st hr. Liver function tests were within normal range. Her preliminary coagulation screening test showed both PT as well as aPTT to be prolonged beyond 120 sec each. She was further sent for complete laboratory evaluation for bleeding disorder. In view of the history of foul smelling stools, suggesting malabsorption, stool sample was analysed which showed presence of fat globules. USG was reported as normal study. Blood group was O positive.Abetalipoproteinemia is a very rare metabolic, autosomal recessive disease resulting from mutations encoding microsomal triglyceride transfer protein (MTP) leading to deficiencies in the apolipoproteins B-48 and B-100 with reported prevalence of less than one case per 100,000. Typical manifestations are failure to thrive, hypocholesterolaemia and fat malabsorption. Other features like fatty liver, acanthocytosis, and anaemia are usually present in infancy and neuro-ocular complications during adolescence. Early diagnosis and management can prevent disease progression

RECK and TIMP-2 mediate inhibition of MMP-2 and MMP-9 by Annona muricata

Up-regulation of MMP-2 and MMP-9 plays a significant role in promoting cancer progression by degradingthe components of the extracellular matrix, thereby enhancing the migration of tumor cells. Although the antiproliferative and apoptotic effect of Annona muricata is well established, its effect on MMP-2 and MMP-9, amajor target in several types of cancers, has not been studied. Powdered samples of various parts of A.muricata like fruit, stem, seed, and twig extracted using aqueous methanol showed significant dose-dependentinhibition of MMP-2 and MMP-9 in a highly metastatic fibrosarcoma cell line, HT1080. Additionally, theseextracts also up-regulated the expression of several endogenous inhibitors of MMP-2 and MMP-9 likeREversion-inducing Cysteine-rich protein with Kazal motifs (RECK) and Tissue Inhibitor of Metalloproteinase-2 (TIMP-2). Furthermore, primary cells developed from tumor tissues obtained from patients notexposed to chemotherapy, also exhibited similar results. Remarkably, the inhibition of MMP-2 and MMP-9observed was tumor specific, with the A. muricata fruit extract showing only 2% inhibition in cells obtainedfrom normal tissues, when compared to 60% inhibition observed in cells obtained from tumor samples. Thepresent study elucidates a novel mechanism by which A. muricata extracts selectively exhibit their anti-canceractivity in tumor cells by down-regulating MMP-2 and MMP-9 that are important biomarkers in cancer.

Type B congenital pyloric atresia: a case report

This is a case of congenital pyloric atresia type B not associated with any other anomaly rare condition, seen as an isolated anomaly with excellent prognosis) of  two days female child presenting with vomiting since birth. X-ray abdomen showed only stomach air bubble, sonography showed distended stomach with echoes and on barium meal no passage of contrast was seen beyond pyloric antrum even after 24 hours. Patient underwent Heineke-Mikulicz pyloroplasty and postoperative recovery was uneventful.

Peripheral Blood Smear Morphology- A Red Flag in COVID-19

Covid-19 pandemic has affected the whole word medically, economically and emotionally. It is being considered as the biggest pandemic after the Spanish flu, with very high degree of morbidity and mortality in those with complications. The diagnostic and treatment criteria of this novel virus are being updated frequentlyas nothing much is known about it. This highlights the importance of hematology lab parametersin Coviddiagnosis and prediction of disease progression. Multiple studieson complete blood counts and it’s derived parametershave beenconductedin patients of Covid-19however limited literature is available whichdiscussesthe morphology of circulatingblood cellsin Covid-19 cases.This short communicationis presentedwith the purpose of highlighting theperipheral blood findings of 50 lab confirmed Covid-19 cases admitted atSuper SpecialtyPediatric Hospital and Post Graduate Teaching Hospital, NOIDA.Keywords: Covid-19; morbidity and mortality; SARS CoV2; real time RT-PCR.Short Communication

Acute urinary retention and gastroparesis due to self-medication in an elderly male

An eighty-five years old man complained of difficulty in swallowing for relatively dry food items and water with occasional episodes of vomiting. He was a diabetic and hypertensive patient on treatment for long, suddenly reported pain and discomfort in the abdomen with inability to pass urine. All the parameters were within normal limits except prostate being 70 ml enlarged. He was catheterized with diagnosis of BPH with chronic urinary retention. TURP was advised but the case did not consent for it. On close scrutiny of detailed history, it was observed that the patient was on self-medication of homeopathic drugs which were causing smooth muscle relaxation of bladder and GIT, causing difficulty in deglutition and constipation. On discontinuation of drugs, these effects disappeared and the case did not need any further catheterization, concluding that the acute urinary retention was caused by self-medication induced constipation. It is hence inferred that self-medication with homeopathic medicines should be avoided specially by elderly as aging effects and co-morbid condition often coexist.

Correlation of lateral placental location with development of preeclampsia

Background: Preeclampsia is a complex clinical syndrome which involves multiple organ systems and remains the principle cause of maternal and perinatal morbidity and mortality. Preeclampsia is a disease of trophoblastic tissue. Placental abnormality is one of the initial events in patients who are destined to develop pregnancy induced hypertension subsequently. Objective of this study was to evaluate the association of laterally located placenta on ultrasound with development of preeclampsia.Methods: This prospective observational study was conducted on 200 antenatal women with singleton pregnancy at 18-24 weeks of gestation who attended antenatal clinic of obstetrics and gynaecology, PGIMS Rohtak from October 2017 to October 2018. Detailed antenatal transabdominal ultrasound along with placental location was done between 18-24 weeks of gestation in women who fitted into inclusion criteria. All the antenatal women belonged to 18-24 weeks of gestation were included in the study except those women with chronic hypertension, diabetes mellitus, renal disease, severe anaemia, thyrotoxicosis, low lying placenta, previous history of preeclampsia or eclampsia.Results: Out of 200 antenatal women, 84 had lateral placenta while 116 had central placenta. Out of these 84 women who had lateral placenta, 55 women (65.5%) developed preeclampsia and out of 116 (58%) women who had central placenta, 28 women (24.1%) developed preeclampsia.Conclusions: From the above study, we concluded that women with laterally located placenta by ultrasound at 18-24 weeks of gestation have greater risk of developing preeclampsia.

A clinical study on the surgical management of intestinal obstruction

Background: Intestinal obstruction remains one of the common emergencies encountered by general surgeons all over the world. Acute intestinal obstruction occurs when there is a disruption in the frontward flow of intestinal contents.Methods: This study is a prospective study conducted in Dr. D Y Patil Medical College and Hospital, Pimpri, Pune. Patients coming to the hospital with signs and symptoms suggestive of intestinal obstruction and willing for surgical management in our hospital were included after taking written and informed consent.Results: In our study, pain abdomen and abdominal distension was the most common presenting complaints in 90% and 92% of the patients respectively. On palpation, 96% of the patients had abdominal tenderness, 72% of the patients had guarding and 12% of the patients had rigidity. On auscultation, all patients had some abnormality with regard to bowel sounds. It has been noted that intestinal strictures and abdominal adhesions were amongst the most common causes of intestinal obstruction in our study.Conclusions: Prompt clinical assessment aided by radiological imaging is of crucial importance in reaching the diagnosis of intestinal obstruction. Decision regarding surgical intervention is taken based on the initial presentation of the patient, and his/her response to first line conservative management and fluid resuscitation

DNA base excision repair genes variants rs25487 (X-ray repair cross-complementing 1) and rs1052133 (human 8-oxoguanine glycosylase 1) with susceptibility to ovarian cancer in the population of the Jammu region, India

Background: Ovarian cancer is highly prevalent in the population of Jammu, in India; the ovarian cancer ranks third among other types of cancer prevalent in females. However, association studies on ovarian cancer are lacking in this region. We aimed to investigate the disease susceptible variants rs1052133 (human 8-oxoguanine glycosylase 1 [hOGG1]) and rs25487 (X-ray repair cross-complementing 1 [XRCC1]) with ovarian cancer in population of Jammu, India. Materials and Methods: The study conducted in the Shri Mata Vaishno Devi University is a 3-year study which included a total of 280 well-characterized samples (130 ovarian cancer cases and 150 healthy controls). hOGG1 and XRCC1 polymorphisms were determined by polymerase chain reaction-based restriction fragment length polymorphism, and these genotyping results were confirmed by Sanger sequencing. Hardy–Weinberg equilibrium for both single-nucleotide polymorphisms (SNPs) was assessed using the Chi-square test. The allele and genotype-specific risks were estimated by odds ratios with 95% confidence intervals. Results: In this preliminary study, SNP rs1052133 showed protection with ovarian cancer (P = 0.042). The SNP rs25487 was not found associated with ovarian cancer (P = 0.271). Conclusion: Our results indicate that the G allele of rs1052133 imparts protection to the population whereas variant rs25487 was not associated with ovarian cancer in population from the Jammu region, indicating that larger sample size is needed for further statistical validation. Further, association of other SNPs in these genes should also be carried out as their role cannot be ruled out.