Indirect Determination of Maximal Oxygen Consumption (VO2Max) and Its Correlation with Body Mass Index

Background: The current study was designed to evaluate cardio respiratory fitness in terms of VO2max in young healthy males and to correlate between body mass index and cardio respiratory fitness. Methods: One hundred twenty-five apparently healthy male subjects in the age group of 18 to 25 years were included in this study group. Body mass index was measured as weight in kilograms divided by height in meters square. Cardio respiratory fitness in terms of VO2max was predicted by following the protocol of Treadmill Jogging Test (TMJ). Results: There was a highly significant negative correlation between body mass index and VO2max, r = -0.75 p<0.0001. Conclusion: The result suggests that the reduced cardiac performance during progressive work rate exercise in obese individuals. Greater the BMI, more severe will be the functional impairment, suggesting excessive amount of body fat on cardio-respiratory functions and oxygen uptake by working muscles

Culture-positive unilateral panophthalmitis in a serology-positive case of dengue hemorrhagic fever

Dengue fever, a mosquito-borne disease commonly found in the tropics, is one of the most prevalent forms of Flavivirus infection in humans. Symptomatically, it is characterized by fever, arthralgia, headache, and rash. Ophthalmic manifestations can involve both the anterior and posterior segment. Panophthalmitis is rare in dengue hemorrhagic fever, and there is no report of culture-positive panophthalmitis in this setting. Here, we report a case of a serology-positive 33-year-old male patient of dengue hemorrhagic fever who developed sudden onset pain, redness, and proptosis in the right eye. The patient subsequently developed panophthalmitis in his right eye, and Bacillus cereus was isolated from eviscerated sample. This case provides unique insights into pathogenesis of panophthalmitis in dengue and highlights the management options.

Variations in Iron Status Indicators in Different Phases of Menstrual Cycle – A Study of Two Age-Matched Socio- Economic Groups of 18 – 25 Years of Age.

Background: Iron requirements are increased in adolescent girls with growth and the onset of menarche and remain high in women until menopause. Methods: We conducted a study on two study groups of girls in age group 18-25 years belonging to different socioeconomic classes as per the Modified Kuppuswamy’s Scale to study the effect of the phases of menstrual cycle & socioeconomic class on the iron status indicators (Hb, Serum Iron, TIBC, MCV & TS%).Menstrual phases were defined and blood samples were drawn from all the girls in all the 3 phases (menstrual, follicular & luteal) and Hb, Serum iron & Total iron binding capacity were assessed on a semi-auto-analyzer & MCV was estimated using a fully automated CBC machine. Transferrin Saturation was derived as Serum Iron / TIBC × 100. Results: We found significant (p< 0.01) difference in iron status indicators in both our groups, the values of iron status indicators varied significantly according to the menstrual cycle, with values highest during the luteal phase and lowest during the menstrual phase. From our observations we can conclude that the nutritional status (assessed by the height, weight & BMI) and the iron status indicators both differ significantly in the two age-matched comparable socio-economic groups. Conclusion: socioeconomic class has a major determining role on an individual’s health. The effect of hormonal fluctuations during the menstrual cycle also has a part to play in the variation of iron status measures, which has to be considered while measuring them in a female during her reproductive years

Tricuspid annulus: A spatial and temporal analysis.

Background: Traditional two‑dimensional (2D) echocardiographic evaluation of tricuspid annulus (TA) dilation is based on single‑frame measurements of the septolateral (S‑L) dimension. This may not represent either the axis or the extent of dynamism through the entire cardiac cycle. In this study, we used real‑time 3D transesophageal echocardiography (TEE) to analyze geometric changes in multiple axes of the TA throughout the cardiac cycle in patients without right ventricular abnormalities. Materials and Methods: R‑wave‑gated 3D TEE images of the TA were acquired in 39 patients undergoing cardiovascular surgery. The patients with abnormal right ventricular/tricuspid structure or function were excluded from the study. For each patient, eight points along the TA were traced in the 3D dataset and used to reconstruct the TA at four stages of the cardiac cycle (end‑ and mid‑systole, end‑ and mid‑diastole). Statistical analyses were applied to determine whether TA area, perimeter, axes, and planarity changed significantly over each stage of the cardiac cycle. Results: TA area (P = 0.012) and perimeter (P = 0.024) both changed significantly over the cardiac cycle. Of all the axes, only the posterolateral‑anteroseptal demonstrated significant dynamism (P < 0.001). There was also a significant displacement in the vertical axis between the points and the regression plane in end‑systole (P < 0.001), mid‑diastole (P = 0.014), and mid‑systole (P < 0.001). Conclusions: The TA demonstrates selective dynamism over the cardiac cycle, and its axis of maximal dynamism is different from the axis (S‑L) that is routinely measured with 2D TEE.

Dynamic changes in the ischemic mitral annulus: Implications for ring sizing.

Objectives: Contrary to the rest of the mitral annulus, inter‑trigonal distance is known to be relatively less dynamic during the cardiac cycle. Therefore, intertrigonal distance is considered a suitable benchmark for annuloplasty ring sizing during mitral valve (MV) surgery. The entire mitral annulus dilates and flattens in patients with ischemic mitral regurgitation (IMR). It is assumed that the fibrous trigone of the heart and the intertrigonal distance does not dilate. In this study, we sought to demonstrate the changes in mitral annular geometry in patients with IMR and specifically analyze the changes in intertrigonal distance during the cardiac cycle. Methods: Intraoperative three‑dimensional transesophageal echocardiographic data obtained from 26 patients with normal MVs undergoing nonvalvular cardiac surgery and 36 patients with IMR undergoing valve repair were dynamically analyzed using Philips Qlab® software. Results: Overall, regurgitant valves were larger in area and less dynamic than normal valves. Both normal and regurgitant groups displayed a significant change in annular area (AA) during the cardiac cycle (P < 0.01 and P < 0.05, respectively). Anteroposterior and anterolateral‑posteromedial diameters and inter‑trigonal distance increased through systole (P < 0.05 for all) in accordance with the AAs in both groups. However, inter‑trigonal distance showed the least percentage change across the cardiac cycle and its reduced dynamism was validated in both cohorts (P > 0.05). Conclusions: Annular dimensions in regurgitant valves are dynamic and can be measured feasibly and accurately using echocardiography. The echocardiographically identified inter‑trigonal distance does not change significantly during the cardiac cycle.

Echocardiography derived three-dimensional printing of normal and abnormal mitral annuli.

Aims and Objectives: The objective of this study was to assess the clinical feasibility of using echocardiographic data to generate three‑dimensional models of normal and pathologic mitral valve annuli before and after repair procedures. Materials and Methods: High‑resolution transesophageal echocardiographic data from five patients was analyzed to delineate and track the mitral annulus (MA) using Tom Tec Image‑Arena software. Coordinates representing the annulus were imported into Solidworks software for constructing solid models. These solid models were converted to stereolithographic (STL) file format and three‑dimensionally printed by a commercially available Maker Bot Replicator 2 three‑dimensional printer. Total time from image acquisition to printing was approximately 30 min. Results: Models created were highly reflective of known geometry, shape and size of normal and pathologic mitral annuli. Post‑repair models also closely resembled shapes of the rings they were implanted with. Compared to echocardiographic images of annuli seen on a computer screen, physical models were able to convey clinical information more comprehensively, making them helpful in appreciating pathology, as well as post‑repair changes. Conclusions: Three‑dimensional printing of the MA is possible and clinically feasible using routinely obtained echocardiographic images. Given the short turn‑around time and the lack of need for additional imaging, a technique we describe here has the potential for rapid integration into clinical practice to assist with surgical education, planning and decision‑making.

Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children

BACKGROUND: Neuraminidase inhibitors (NIs) are stockpiled and recommended by public health agencies for treating and preventing seasonal and pandemic influenza. They are used clinically worldwide. OBJECTIVE: To describe the potential benefits and harms of NIs for influenza in all age groups by reviewing all clinical study reports of published and unpublished randomised, placebo-controlled trials and regulatory comments. METHODS Search methods: We searched trial registries, electronic databases (to 22 July 2013) and regulatory archives, and corresponded with manufacturers to identify all trials. We also requested clinical study reports. We focused on the primary data sources of manufacturers but we checked that there were no published randomised controlled trials (RCTs) from non-manufacturer sources by running electronic searches in the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE (Ovid), EMBASE, Embase.com, PubMed (not MEDLINE), the Database of Reviews of Effects, the NHS Economic Evaluation Database and the Health Economic Evaluations Database. Selection criteria: Randomised, placebo-controlled trials on adults and children with confirmed or suspected exposure to naturally occurring influenza. Data collection and analysis: We extracted clinical study reports and assessed risk of bias using purpose-built instruments. We analysed the effects of zanamivir and oseltamivir on time to first alleviation of symptoms, influenza outcomes, complications, hospitalisations and adverse events in the intention-to-treat (ITT) population. All trials were sponsored by the manufacturers. MAIN RESULTS: We obtained 107 clinical study reports from the European Medicines Agency (EMA), GlaxoSmithKline and Roche. We accessed comments by the US Food and Drug Administration (FDA), EMA and Japanese regulator. We included 53 trials in Stage 1 (a judgement of appropriate study design) and 46 in Stage ...

Cerebellar medulloblastoma in a 65 year old Indian male.

A case of cerebellar medulloblastoma in a 65 year old male is reported. Cerebellar medulloblastoma is classically seen during childhood, and less than 25% of these tumours are found in adults below 40 years of age. Rarely, cases are reported above the age of 40 years. So far only three cases have been reported in patients aged above 64 years and none of these case reports are from India.

Spinal dysraphism.

Spinal dysraphism (SD) is characterized by maldevelopment of neural tube, notochord, mesoderm and cutaneous ectoderm. Incidence of SD is 2-4/1000 live births. One hundred and nineteen patients operated from January 1991-June 1996 at Department of Neurosurgery, All India Institute of Medical Sciences, were studied. Only 21 patients (17.6%) presented when they were less than one year old and 17 patients came in adult age group (> 16 years). Lumbar and lumbosacral region was the commonly involved site in 81 patients (74.7%). Weakness of lower limbs (74%), difficulty in walking (54%), muscle atrophy (41.2%) were the commonest indicators of motor system involvement. Loss of sensation, trophic ulcer, backache were seen in 45, 14, 10 patients respectively. Cutaneous lipoma (26%), hypertrichiosis (20%), dermal sinus (13.4%), midline dimples (7%) were the important cutaneous markers. Foot and limb deformity was seen in 25% cases. Tethering of cord, syringomyelia & split cord malformation were the most common radiological findings. Only 10% of our patients had hydrocephalus that required shunt. Out on 119 cases operated, 43 improved, Twenty had sensory improvement and 18 showed motor improvement. Fifteen patients regained continence. Twelve patients were lost to follow-up. Sixty-seven patients had no change in neurological status, post-operatively. Six cases deteriorated in terms of motor or sensory deficit and one patient lost continence. CSF leak (8%) and wound infection (6%) were the common complications. Six patients required second surgery as T.P. Shunt (4), rotation flap (1), reexploration and duraplasty (1).

In vivo and in vitro investigations on rotenoids from Indigofera tinctoria and their bioefficacy against the larvae of Anopheles stephensi and adults of Callosobruchus chinensis.

Various plant parts of Indigofera tinctoria L. were collected separately at different growth stages and analysed for their rotenoid content. The total rotenoid content decreased with age; among the plant parts, maximum content was in leaves and minimum in stem. The identity of different rotenoids was confirmed by melting point, mixed melting point, UV and infrared spectral studies, and gas-liquid chromatography. Six rotenoids (deguelin, dehydrodeguelin, rotenol, rotenone, tephrosin and sumatrol) were isolated, identified and quantified in vivo. The static cultures of Indigofera tinctoria were established from seeds on RT medium, and maintained for a period of six months by frequent subculturings. Only four rotenoids were present in callus cultures; sumatrol and tephrosin were absent. The maximum content was found in eight week old tissue after fresh subculturings and minimum at 2 weeks. The toxicological studies of in vivo and in vitro extract against the pulse beetle (Callosobruchus chinensis) and mosquito (Anopheles stephensi) larvae, showed that rotenoids were more effective against mosquito larvae than Callosobruchus chinensis. Extracts from callus was more effective against both the test animals than that from plant parts.