ABSTRACT
Objectives: To determine the association of eNOS (T786C and 27bp VNTR) gene polymorphism with the risk of type II diabetes mellitus and diabetic nephropathy in North India. Methods: The prospective case control study was conducted over a period of 18 months. A total of 100 patients of Type 2 Diabetes Mellitus (A1: 50 cases without Diabetic nephropathy-DN and 50 cases with DN) aged 18-75 years and 50 healthy adults as control (Group B) were included. The endothelial nitric oxide gene variant (T786C and 27bp VNTR) genotypes and alleles were studied. Odds ratio with 95% CI was calculated for genotype and alleles for the occurrence of diabetes and DN. p value of less than 0.05 was considered as significant. Results: With Bb as reference(27bp VNTR), the odds ratio for Ab in the three groups (A1,A2,B) was 2.243, 1.545 and 0.746 respectively; and for Aa was 3.043, 3.058 and 1.878 respectively; with TT as reference (T786C), it was 1.573, 1.55 and 1.055 respectively for TC; and for CC it was 2.121, 2.063 and 2.348 respectively. The OR was comparable among the study groups and control for all genotypes and alleles (p>0.05). Conclusion: In conclusion, there was a trend towards higher predilection of DN with aa genotype and a allele in 27 VNTR, CC genotype and C allele of -786T>C polymorphism however it was not found to be statistically significant. Future large sample studies are required to account for the ethnic variation for a clearer association of the genes and their associated risk with Diabetes and its complications.
ABSTRACT
Background:Spasmolytics and NSAIDs are a therapy of choice in colic pain. However, the tolerability and effectiveness of this combination remains unexplored. The aim of this prospective, single-arm, open label, multicenter study was to evaluate the safety and effectiveness of Anafortan-N�(fixed-dose combination of camylofin dihydrochloride 50 mg + nimesulide 100 mg) in patients with acute colicky abdominal pain.Methods: In all, 295 patients with acute colicky abdominal pain and at least one episode of colicky pain in the last 24 hours were enrolled in this study. None of the patients were hospitalized. All patients were advised Anafortan-N畉ablets twice daily orally for 5 days. The safety of Anafortan-N畐as assessed by number and percentage of patients with adverse events (AEs) and change in the severity and frequency of AEs by the end of treatment. The tolerability was determined by number and percentage of patients who hadto discontinue the treatment due to AEs. The effectiveness was evaluated as percentage change in the mean intensity of pain score (based on a 100-mm visual analog scale) from baseline to end of treatment.Results: Overall, 14 (4.7%) patients reported 14 AEs, all of which were treatment-emergent and non-serious. Of the 14 AEs, 7 AEs were mild, 6 AEs were moderate, and 1 AE was severe. No serious adverse events (SAEs) were reported. No adjustment of the study medication was required in response to any of the AEs, and none of the AEs led to discontinuation of the study treatment. At end of treatment(EOT), the pain intensity significantly (p<0.0001) reduced to 1.7�49 with a mean change of -69.9�.42 from baseline, and the daily pain intensity significantly (p<0.0001) reduced to 0.1�38 with a mean change of -3.5�77 from baseline.Conclusions: Among Indian patients presenting with acute abdominal colicky pain, twice daily treatment with a FDC of camylofin dihydrochloride 50 mg and nimesulide 100 mg (Anafortan-N�) showed significant reduction in pain intensity with very few side effects, thereby confirming its safety, tolerability, and effectiveness in acute colicky abdominal pain.
ABSTRACT
Background: There is limited data from India regarding medical management of congenital hyperinsulinism (CHI). Objective: To study the molecular diagnosis, medical management and outcomes of children with CHI. Study design: Ambispective. Participants: Children with CHI admitted in from December, 2011 till March, 2020 at a tertiary care referral hospital. Outcomes: Clinical and genetic profile, treatment, and response Results: 42 children with a median age of 3 days (range 1 day to 6 years) were enrolled, of which 23 (54.7%) were diazoxideresponsive. Mutations were identified in 28 out of 41 (68.2%) patients. The commonest gene affected was ABCC8 in 22 patients. The pathogenic variant c.331G>A in ABCC8 gene was identified in 6 unrelated cases from one community. Good response to daily octreotide was seen in 13 of the 19 (68.4%) diazoxide-unresponsive patients. Monthly long-acting octreotide was initiated and daily octreotide could be stopped or tapered in 9 patients. Sirolimus was tried with variable response in 6 patients but was discontinued in 5 due to adverse effects. Four patients had focal CHI, of which one underwent partial pancreatic resection. The disease severity reduced with age and neurodevelopment was good in the patients with identifiable genetic defects who were optimally managed. Conclusions: Medical management of CHI is effective, if compliance can be ensured, with good quality of life and neurological outcomes.
ABSTRACT
The coordination between phytohormones regulation, stomatal behaviour (stomatal index and opening/closing) and gas exchange are potent determinants of plant survival under drought stress. However, we found a knowledge gap in the mechanism regulating the fine-tuning of these features during drought. In order to address this we evaluated gas exchange, stomatal behaviour and endogenous phytohormones content in two cotton varieties (LRA-5166 and NBRI-67) differing in drought sensitivity during water deficit conditions. Variety specific differences were recorded in net photosynthesis rate (A), transpiration rate (E) and stomatal conductance (gs) with significantly less decrease in drought tolerant LRA-5166 than drought sensitive NBRI-67. The abscisic acid (ABA) accumulation was significantly increased in LRA-5166 while reduced in NBRI-67 under water deficit, which was accompanied by relatively less reduced 6-benzylaminopurine (6-BAP) level in LRA-5166 than NBRI-67.Thus, improved ABA/6-BAP ratio was observed in both the varieties of cotton. Critically, LRA- 5166 has reduced stomatal index, aperture size and significantly higher A and intrinsic water use efficiency (WUEi), thus higher drought tolerance than NBRI-67. Furthermore, we found that endogenous ABA predominantly maintains the stomatal behaviour and regulates its physiology either by antagonizing 6-BAP or alone to coordinate with water deficit signals. Overall, our findings describe a new insight as to how drought modulates endogenous ABA and 6-BAP homeostasis in cotton leaf and the mechanism of stomatal regulation by ABA and 6-BAP in cotton.
ABSTRACT
Abstract Objectives To evaluate different types of perianal fistulas and their complications on magnetic resonance imaging (MRI) and to compare plain, contrast, and jelly magnetic resonance fistulography findings. Materials and Methods This prospective study was performed in 30 patients who presented with perianal pus discharge or external fistulous opening. Magnetic resonance imaging of the perianal region before and after giving intravenous contrast and after injecting jelly through a percutaneous opening was performed on a 3T scanner and the results were correlated. Results The mean age of the patients was 40.13±13.88 years (range 19-75 years). The male to female ratio was 14:1. The most common type of fistula was St. James classification type I, which was seen in 13 patients (43%), followed by type IV in 30%, type III in 16%, type II in 6.66%, and type V in 3.33% of the patients. Using agreement analysis, we compared the number of primary and secondary tracts, internal openings, and horseshoe tracts and found a significant agreement between plain and post Jelly MRI fistulography (kappa statistic close to 1).When comparing plain and contrast MRI, there was significant agreement in the primary and secondary tracts, while statistically insignificant results were obtained (p>0.05) for the horseshoe tract and internal openings. Contrast injection was helpful in 7 subjects (23.3%) as peripheral enhancement of abscesses were better delineated. Conclusion Magnetic resonance imaging is the one stop diagnostic modality for perianal fistulas. Acquisition of axial (Ax) T2, axial T2 FS, coronal T2 and coronal T2 FS sequences without administering intravenous contrast or jelly is usually sufficient for the diagnosis of fistulas and their complications.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Magnetic Resonance Imaging , Rectal Fistula/diagnostic imaging , Anal Canal/diagnostic imagingABSTRACT
Abstract INTRODUCTION: We compared the hepatitis C virus (HCV) core antigen test with the HCV RNA assay to confirm anti-HCV results to determine whether the HCV core antigen test could be used as an alternative confirmatory test to the HCV RNA test. METHODS: Sera from 156 patients were analyzed for anti-HCV and HCV core antigen using a chemiluminescent microparticle immunoassay (Architect i2000SR) and for HCV RNA using the artus HCV RG RT-PCR Kit (QIAGEN) in a Rotor-Gene Q instrument. RESULTS: The diagnostic sensitivity, specificity, and positive and negative predictive values of the HCV core antigen assay compared to the HCV RNA test were 77.35%, 100%, 100%, and 89.38%, respectively. HCV core antigen levels showed a good correlation with those from HCV RNA quantification (r =0.872). However, 13 samples with a viral load of less than 4000 IU/mL were negative in the HCV core antigen assay. All gray-zone reactive samples were also RNA positive and were positive on repeat testing. CONCLUSIONS: The Architect HCV core antigen assay is highly specific and has an excellent positive predictive value. At the present level of sensitivity (77%), the study is still relevant in a low-income setting in which most of the HCV-positive patients would go undiagnosed, since HCV RNA testing is not available and/or not affordable. HCV core antigen testing can also help determine the true burden of infection in a population, considering the fact that almost 50% of the anti-HCV positive cases are negative for HCV RNA.
Subject(s)
Humans , Hepatitis C/diagnosis , Hepacivirus/genetics , RNA, Viral , Sensitivity and Specificity , Hepatitis C Antigens , Hepatitis C AntibodiesABSTRACT
Background: Hypertensive disorders of pregnancy and their complications rank as one of the major causes of maternal morbidity and mortality. The objective of the study was to compare the level of serum LDH in normotensive and hypertensive pregnant women and to correlate the levels with maternal and foetal outcome.Methods: Study was conducted in department of obstetrics and gynecology Kamla Nehru State Hospital for Mother and Child, Indira Gandhi Medical College, Shimla w.e.f. 15th July, 2014 to 14th July, 2015. Pregnant women enrolled in the study were divided into following groups: - Group 1- Age and parity matched 202 normotensive pregnant women. Group 2- 202 women with hypertensive disorders of pregnancy as per the inclusion and exclusion criteria. Subjects were also divided according to the serum LDH levels into following groups: LDH <600 IU/L, LDH-600-800 IU/L and LDH >800IU/L. The maternal and foetal outcome was correlated with the serum level of LDH. One-way analysis of variance (ANOVA) and the chi-square test were used to compare the results. Differences were considered significant when p<0.05.Results: Severely preeclamptic and eclamptic patients were significantly younger, with low gravidity and parity. The symptoms and complications of preeclampsia and eclampsia along with perinatal mortality were increased significantly in patients with LDH >800 IU/L as compared with those who had lower levels.Conclusions: Lactate dehydrogenase is a useful biochemical marker that reflects the severity of and the occurrence of complications of preeclampsia and eclampsia. Identification of high-risk patients with elevated levels of lactic dehydrogenase, their close monitoring, and prompt, correct management may prevent these complications, with a subsequent decrease in maternal foetal morbidity and mortality.
ABSTRACT
Symphalangism is rare congenital disorder characterised by ankylosis of interphalangeal joints of hands and feet. The fusion can involve the proximal or the distal joints; however, involvement of the proximal interphalangeal joints is more common. There may other associated skeletol and non-skeletol abnormalities. Here the author reports a 14 year old girl with symphalangism involving the interphalangeal joints of the thumbs of bilateral hand. She did not have any functional impairment and hence no medical or surgical intervention was performed. As involvement of thumbs is very rare condition, author would like to report it.
ABSTRACT
Pulse oximetry is an important screening technique to intensify timely diagnosis of critical cyanotic congenital heart disease in neonates which is a noninvasive, safe and an easy method. It is a highly specific test having low false positive rates. This screening test was conducted in Department of Pediatrics, Darbhanga Medical College & Hospital, Laheriasarai, Darbhanga, Bihar, between 24 hours and 36 hours after birth, with use of the right hand of infants and either foot to diminish false positive results.METHODSData for study has been collected from birth records from Darbhanga Medical College & Hospital, Bihar, and included- 1. saturation level from either feet and right hand for the primary and further recurrence of screening. 2. outcomes of the echocardiographic test findings. 3. important non-cardiac illness diagnosed at the hospitalization for infants which failed screening for cyanotic CHD. For the correction of errors related to data of the study, we satisfied autonomous investigations of pulse oximetry requiring AAP CCHD screening algorithm to identify infants to pass with a saturation ≥95% in hand or either foot and a ≤3% difference and those falling after finishing 3 transitional screening tests. After three consecutive measurements, there is difference of SpO2 of more than 3% between pre-ductal and post-ductal SpO2.RESULTSThe combination of pulse oximetry and physical examination improved the sensitivity to up to 57.14% with a specificity of 99.73%. The overall mortality rate of CCHD was 36.8% [7 out of 19]. The mortality rate of early detection were 37.5% [6 out of 16]. Late detection of CCHD has mortality rate of 33.3% [1 out of 3]. 123 [13.1%] and 70 [7.4%] newborns have either foot or right hand SpO2 level < 95% among 941 study newborns at the time of the initial screening. The mean SpO2 level of either feet and right arm of study newborns were 95.8% [SD 2.3] and 96.0% [SD 2.2] respectively. Either feet and right arm level of SpO2 <95% and either feet to right arm level of SpO2 difference of >3% among 142 [15.1%] study newborns.CONCLUSIONSPulse oximetry screening for primary diagnosis of critical cyanotic CHD is an easy, economical and non-invasive test which covers the essential criteria in addition to worldwide newborn screening panel. Extensive approval and implementation can considerably reduce the morbidity in newborns infants and is likely to be an additional important tool in low resource settings where most of newborn infants are born without prenatal diagnosis. Although, this study showed reduced sensitivity of pulse oximetry for critical cyanotic CHD nearly <50%.
ABSTRACT
Background: Hepatitis C virus (HCV) is a major causative agent of parenterally acquired hepatitis. Vertical transmission of HCV occurs from mother to infant during pregnancy, delivery, or neonatal period. Hepatitis C infection among pregnant females can adversely affect both mother and fetus, leading to chronic infection in infants who later develop liver cirrhosis and hepatocellular carcinoma. Objective of the study was to evaluate the prevalence of hepatitis C among pregnant females attending antenatal clinic.Methods: A hospital based cross-sectional study was done over a period of six months from January to June 2019. A total of 550 pregnant females were included in the study who attended Antenatal Clinic for routine check-up and whose blood samples were sent to Microbiology Laboratory for screening of anti-HCV antibodies by Enzyme linked Immunosorbent Assay (ELISA) method.Results: Out of 550 pregnant females tested, 3 were found to be reactive to anti-HCV antibodies by ELISA; hence the prevalence was found to be 0.5%. All 3 seropositive females belonged to age group 26-35 years, were indoor patients (IPD) and belonged to lower socio-economic class. Majority of seropositive females belonged to urban areas (66.7%, 2/3) as compared to those from rural areas (33.3%, 1/3).Conclusions: Although, prevalence of hepatitis C was found to be less among pregnant females attending ANC of this institute, still routine screening of all pregnant females for anti-HCV antibodies is highly recommended, for timely detection of disease in mothers and prevention of its transmission to infants.
ABSTRACT
Background: Hepatitis B infection is one of the most common public health problems worldwide. Hepatitis B virus Surface Antigen (HBsAg) positive mothers may transmit the virus vertically to neonates transplacentally during pregnancy, perinatally during delivery or postnatally through breast milk. Such neonates being carriers of virus are at a very high risk of developing chronic liver diseases at a younger age and also, they act as reservoirs of infection in the community. Objective of the study is to evaluate the seroprevalence of HBsAg in pregnant females attending Antenatal Clinic.Methods: A hospital based cross-sectional study was done from January to June 2019. A total of 840 pregnant females were included in the study who attended Antenatal Clinic for routine checkup whose blood samples were sent to Microbiology Laboratory for screening of HBsAg by Enzyme Linked Immunosorbent Assay (ELISA).Results: Out of 840 pregnant females included in the study, 8 were reactive to HBsAg, hence, prevalence was found to be 0.95%. The seroprevalence of HBsAg was found to be more (1.40%) in 26-35 year females. Maximum seropositivity was seen in females from urban areas (1.0%), those attending OPD of ANC (1.03%) and those who belonged to lower socio-economic class (1.02%).Conclusions: Routine free screening for HBV infection should be offered to all antenatal females to reduce the risk of vertical transmission to the neonates born to infected mothers, thereby, preventing them from becoming carriers and developing chronic hepatitis and hepatocellular carcinoma later in life.
ABSTRACT
Background: The present study was conducted to compare the effects of 0.5% isobaric levobupivacaine and 0.5% hyperbaric bupivacaine in pregnant females undergoing caesarean section.Methods: Study was conducted on 100 pregnant females undergoing caesarean section. They were randomly divided into two groups B and L receiving 2 ml of 0.5% hyperbaric bupivacaine and 0.5% levobupivacaine respectively. Two groups were compared with regard to sensory block, motor block, haemodynamic stability and complications if any.Results: Time to achieve sensory blockade till T6 dermatome was prolonged in group B (162.52±80.55 sec) as compared to group L (139.40±49.79 seconds) (p value= 0.087). Prolonged duration of motor blockade was observed in group B (160.76±6.56 minutes) as compared to group L (131.48±14.42 minutes) (p<0.001). Less haemodynamic stability was seen in patients of group B with more incidence of hypotension and bradycardia.as compared to group L.Conclusions: Levobupivacaine is nearly equally effective to bupivacaine to produce sensory and motor blockade with comparable onset time and better haemodynamic stability with lesser side effects.
ABSTRACT
Coronary air embolism is a dreadful complication of cardiac intervention despite careful prevention. In literature reported complications of coronary air embolism ranges from clinically non significant events to cardiogenic shock, myocardial infarction and death. We report a case of massive coronary air embolism in right coronary artery, which results in hypotension and complete heart block in a 33 -year-old female undergoing elective closure of atrial septal defect (ASD) by percutaneous transcatheter intervention. The patient stabilized after timely measures like oxygen support, dopamine infusion, cardiac compression and repeated bolus injection of heparinized saline. She then underwent successful percutaneous ASD device closure.
ABSTRACT
Introduction: Hepatorenal syndrome (HRS) is the most serious complication of renal dysfunction in patients with chronic liverdisease (CLD). Renal arterial vasoconstriction may persist for weeks, even months before an increase of blood urea nitrogenor serum creatinine values can be discovered.[1] Duplex Doppler ultrasonography of the kidneys is an easy and non-invasivemethod to assess blood flow and arterial vascular resistance as a parameter for vasoconstriction.[2-4] Intrarenal resistive index(RI) may be superior to serum creatinine levels as an indicator in patients with liver cirrhosis for the detection of patients at riskfor the development of HRS.Objective: The objective of the study was to correlate renal Doppler indices with serum creatinine levels in various stages ofCLD and to determine its role in predicting the risk for developing HRS in patients of CLD.Materials and Methods: Grayscale, color flow, and duplex Doppler ultrasonography were performed inpatients of CLD, whichwere divided into four groups with increasing clinical severities. There serum creatinine level was compared with renal Dopplerindices in various groups of increasing severity.Results: Most common cause of CLD in our study population was alcoholism (62%). About 65% of cases show irregular liversurface, and irregular liver surface is significantly higher in Groups II, III, and IV versus Group 1. Heterogeneous, homogenous,and fatty echo texture were showed by 78%, 11%, and 11%, respectively. Mean peak systolic velocity and end-diastolic velocityin our study are 33.99 cm/s and 11.55 cm/s, respectively. Mean pulsatility index in cases was 1.17. In our present study, RIlevel was significantly higher in cirrhotic patients, and there is a significant association between RI and study groups. As theseverity of liver disease of group increases, the RI value also gets elevated.Conclusion: Intrarenal RI seems to be a helpful predictor to identify a subgroup of CLD patients with a higher risk of developingkidney failure or HRS, which can translate into the early initiation of treatment for impending HRS.
ABSTRACT
Objective: To study the angiographic profile, treatment andoutcome of Coronary Artery Disease (CAD) in young (< 45years) individuals in India.Methods: Consecutive 132 young adults with CAD reporting totwo tertiary care centres over a period of 1 ½ years wereenrolled as a case control observational study. Subjects whopresented with acute coronary syndrome (ACS), chronic stableangina (CSA), Heart failure or AsymptomaticElectrocardiogram (ECG) abnormalities but confirmed CAD onCoronary Angiogram (CAG) were included. Angiographicprofile, treatment and outcome were analysed with a follow upof one year.Results: Risk factors of abdominal obesity, lipoprotein (a)[Lp(a)] and tobacco consumption were significantly higher instudy group. ST elevation Myocardial Infarction (STEMI) wasthe commonest presentation (71.21%). Single vessel disease(56.06 %) was the commonest angiographic profile with LeftAnterior Descending Artery (LAD) involvement (40.91%).Primary Angioplasty in Myocardial Infarction (PAMI) was donein 42.5% of STEMI and Thrombolysis in 48.9%. Three types ofcoronary involvement were noticed with Type I having discretelesions/thrombus and Type III having multiple segment/arteryinvolvement with differing risk factor profile and outcome.Diffuse and more severe CAD was associated with tobaccouse, abdominal obesity and elevated Lp (a). Late presentation,diffuse disease and persistence of smoking predicted pooreroutcome.Conclusions: CAD in Young commonly presents with AcuteMI and single vessel LAD involvement. Less than half haveaccess to PAMI. Most require stenting although selectedpatients do well with intracoronary thrombolysis. Delayedtreatment and failure to modify risk factors portend badprognosis.
ABSTRACT
Introduction: Giardia lamblia is an important cause of diarrheal disease followed by malabsorption in children throughout the world and is the most frequent pathogenic intestinal protozoan infection. Children having diarrhoea with duration of more than seven days with abdominal pain comprises of Giardia infection . Around 80% of children were affected with Giardia infection as they belong from lower socioeconomical class. Giardia intestinalis causes Giardiasis which is one of the major causes of diarrheal diseases throughout the world. Infection occurred by Giardia may be either asymptomatic or may cause diarrheal illness that can be acute or chronic. In areas of poor sanitation it affects 33% of the people in the developing world. Study aimed to isolate Giardia cyst in paediatric patient under five in Kanpur Region. Material and Methods: The study was carried in the Department of Microbiology, GSVM Medical College, Kanpur, Uttar Pradesh. A total of 197 stool sample were collected and screened for Giardia through microscopy (Iodine and saline mount. Result: Among 197 samples screened. The 18 samples were positive through direct microscopy for Giardia cyst. Maximum amount of parasitic infection was found in age group 3.5-5 years. Conclusion: Stool microscopy is (gold standard); however, its sensitivity is low due to intermittent faecal shedding for Giardiasis which is a common gastrointestinal parasitic infection in tropics. Parasitic infection caused by Giardia lamblia is a major worldwide public health problem. Infection is also associated with complications in early childhood if not treated. For better management of the patients early diagnosis and treatment is required. Drinking water standards, hand hygiene, health education, safe sanitation are factors and should be given priority to minimize such infections.
ABSTRACT
Background: Acute myocardial infarction (AMI) is one of theleading causes of death in the developed world. The presentstudy was planned to assess serum electrolyte profile of AMIpatients.Materials & Methods: A total of 55 AMI patients and 55 agematched and gender-matched healthy controls were includedin the present study. Complete medical and past family historyof all the subjects was obtained. At the time of admission,blood samples were obtained from all the AMI patients. In caseof healthy controls, blood samples were obtained as a part ofroutine medical check-up. All the samples were sent forassessment of serum potassium and sodium levels.Results: Mean electrolyte profile of the subjects of the AMIgroup was found to be significantly lower than that of subjectsof the healthy control group.Conclusion: Fall in the levels of serum sodium and potassiumlevels might increase the probability of occurrence of AMI