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Background: Epidermoid cysts (ECs) are uncommon benign cystic lesions derived from the germinative epithelium. Head and neck ECs constitute only 7% of all ECs whereas only 1.6% are seen intraorally. The floor of the mouth is the commonest intraoral site whereas tongue, lips, buccal mucosa, and jaws are less commonly involved intraoral sites. To date, very few large case series of ECs of head and neck have been published. To the best of our knowledge, this is the third-largest case series of 11 intraoral ECs along with 2 extra-oral cases in the pre-auricular region. Aims: To highlight the typical and atypical features of ECs in the common as well as rare sites and draw attention to its consideration as a differential diagnosis for head and neck masses. Settings and Design: Archival data of 13 histopathological cases identified as ECs were analyzed from the Department of Oral Pathology at a tertiary dental hospital and college in New Delhi from 2007 to 2020. Materials and Methods: The demographic, clinical, radiographic, histopathological features, and treatment modalities were recorded and analyzed. Statistical Analysis Used: Appropriate statistical tests were used. Results: The study found strong male predilection in the ratio of 10:3 with an average age of presentation as 28 years. The pre-auricular region and floor of the mouth were the common sites involved followed by buccal mucosa, lips, and jaws. All patients presented with slowly growing swelling with dysphagia, dyspnea, and dysphonia seen in larger cysts on the floor of the mouth. Microscopically, all cases were lined with stratified squamous epithelium filled with laminated layers of keratin. Two cases showed the presence of melanin. One case showed recurrence even after complete surgical excision. Conclusion: ECs, though a rare entity, should be considered in differential diagnosis for head and neck masses and require close follow-up due to their potential for malignant transformation.
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Background: Prevalence of undernutrition among infants <6 months are very high in India. WAZ is the most sensitive predictor of mortality among infants <6 months as compared to other anthropometric parameters. However, taking weight and calculating z-score in the community setting have many challenges. Taking mid upper arm circumference (MUAC) is more feasible in a field setting. Methodology: A cross-sectional study was conducted with 419 infants <6 months in a tertiary care hospital in India to identify appropriate MUAC cutoffs for identifying underweight (WAZ<-2) and severe underweight (WAZ<-3) among infants <6 months by calculating sensitivities, specificities and Youden indices. Cohen kappa coefficients were calculated to assess agreements between MUAC and WAZ cutoffs. Results: The MUAC cut-offs for underweight and severe underweight were calculated as 11cm (Youden Index: 0.503; sensitivity: 83.4%; specificity: 66.9%) and 10.9cm (Youden Index: 0.504; sensitivity: 76.3%; specificity: 74.1%), respectively. Kappa coefficients to diagnose underweight with MUAC<=11cm was highest at 0.48. Conclusions: The MUAC cut-off of 11cm could reliably be used to screen infants <6 months with underweight and severe underweight for providing appropriate care in the Indian settings.
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Objective: To describe the profile of child sexual abuse (CSA) reported to a tertiary care hospital. Methods: A retrospective analysis of CSA reported in children aged below 18 years from January, 2019 to June, 2022. Results: Out of the 231 cases of sexual abuse reported, 115 (49.8%) were children below 18 years. Most of the victims were children from 10 to 15 years (37.4%), and there were only two male victims. In 89.6%, the perpetrator was known to the victim. Revictimization was seen in 31%. The reported perpetrators were friends (27%), neighbors (34.8%), strangers (10.4%), or fathers (7.8%). Penetrative abuse was seen in 58.3% of reports. External injuries were seen in 6.96%. Eight victims were pregnant and HIV screening was positive in one victim. Conclusion: Early identification of CSA is important to prevent revictimization. Children from all age groups can be victims of CSA. Perpetrators can hail from all walks of life of the children.
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Background: The major cause of morbidity and mortality in patients with portal hypertension is due to oesophageal varices. Upper gastrointestinal endoscopy is considered best to detect varices earlier. It’s an invasive tool which is expensive and increased financial burden among patients. Hence this study is undertaken to find non-invasive indicators of oesophageal varices in cirrhosis patients with portal hypertension and to establish the role of portal vein diameter determined by ultrasonography in predicting the oesophageal varices. Aim and objectives: To detect non-invasive indicators of oesophageal varices in chronic liver disease, to determine the relation between oesophageal varices on upper gastrointestinal endoscopy and portal vein diameter, to determine other non-invasive parameters to identify oesophageal varices. Materials and methods: A cross sectional study on 45 patients, who were diagnosed to have chronic liver disease and are being presented to outpatient department and were admitted in Malla Reddy Institute of Medical Sciences, Suraram over a period of one year under department of general medicine. All the patients with chronic liver disease who underwent upper gastrointestinal endoscopy are included in the study. Results: 45 patients with cirrhosis of liver were included in the study, among which 32 were males and 13 were females with a mean age group of 46 years. On upper gastrointestinal endoscopy 87% of patients had oesophageal varices while other 13% of patients were normal. Mean portal vein diameterwas 13.8 mm and has a positive linear correlation with p<0.01 and positive predictive value of 95.25%. Majority of patients belonged to the platelet count group of 50,000 to 1lakh and its inversely co related to the severity of varices. Majority of patients with oesophageal varices had moderate splenomegaly. Conclusion: Ultrasonography of portal vein diameter and spleen size along with thrombocytopenia are reliable, inexpensive and easily reproducible non-invasive tool in predicting the presence of oesophageal varices and hence can identify the patients who require endoscopy on a prophylactic basis.
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Background: Globally undergraduate medical students have a high prevalence of depression, anxiety, and stress. Few studies from different parts of India have reported the increased prevalence of depression, anxiety, and stress in MBBS students due to the coronavirus disease 2019 (COVID-19) pandemic. However, the causal relationship between COVID-19 and the deranged mental health of the students have not been established. Further, data from the Kanpur city of Uttar Pradesh are lacking regarding the impact of COVID-19 on the mental health of 1st-year MBBS students. Aims and Objectives: The aim of the study was to explore the impact of COVID-19 on depression, anxiety, and stress of MBBS students in their first professional year. Materials and Methods: The present cross-sectional study was conducted on undergraduate medical students of a Government Medical College in Kanpur, Uttar Pradesh, India. Seventy-two male and forty-six female students were involved in the study. Most of the students were 17–25 years old. An online Google form was used to know the score of depression, anxiety, and stress scale (DASS). The demographic profile of the participants was also assessed through an online survey using Google form. The Chi-square test was used for testing relationships between categorical variables wherever required and P ? 0.05 was considered significant. Results: The prevalence of depression, anxiety, and stress was 39%, 52%, and 37%. Gender, age, place of residence, mediation practice, and type of family had no relation with the DASS-21 score. Conclusion: First-year MBBS students of Kanpur have an almost similar prevalence of depression, anxiety, and stress as reported by the previous Indian studies during the pre-COVID-19 pandemic.
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Autoimmune hemolytic anemia (AIHA) secondary to hematological malignancy is well-known and common in the elderly. AIHA associated with infection is less commonly reported in the elderly. We are reporting a case of AIHA in an elderly female with comorbidities, probably secondary to Gram-negative infection. The case was admitted and treated during the peak of the second wave of the COVID pandemic. The treatment of AIHA also had an impact on the progress and outcome of the underlying disease, leading to readmission in a short span of time. The patient also developed a thrombotic complication known to be associated with AIHA.
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Introduction: Transparency in patient care in an emergency department can be projected by capturing data from the medical records of patients. Policy makers envision that transparency in this data will allow the patient to choose the right hospital of his choice. Relative risk is a ratio of the probability of an event occurring in the exposed group versus the probability of the event occurring in the non-exposed group. It is usually used in the scenario of clinical events. In this study we have used it to analyse one of the key performance indicators used in Emergency Department, as per Emerald standards. The problem statement identified in the study is the returning of patients to the Emergency department of a private, tertiary care hospital within 72 hours after the initial visit. A revisit in this study is assumed as an unplanned visit done by the patient within 72 hours with similar presenting complaints. Methodology: A retrospective cohort study for all emergency visits between January to June 2021. People who returned to EMD within 72 hours were compared to other non-re attending patients based on medical diagnosis, patient demographics, mode of arrival, triage category and qualification of doctors in charge. Multivariate analysis using the generalized linear model was conducted on variables associated with 72-hour ED re-attendance. Result: Among 18,355 patients, 128 (0.69%) were in the 72-hour re-attendees’ group. Multivariate analysis showed female gender as more, above 60 years of age, arrival by ambulance, triaged as yellow. Among the ICD-10 diagnosis for the patients who returned, it was not possible to identify one specific condition. But abdominal pain was one reason for the re-visit of a few patients. There was also a significant difference in the seniority ranking of the doctor-in-charge between both groups. Conclusion: Identification of characteristics of patients lead to improved care by surgeons and gastroenterology.
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The gap between demand and supply of organs continues to widen worldwide, encouraging transplant commercialism. While solid organ commerce is most prevalent in impoverished countries, commercialisation of body parts such as tissues is prevalent in economically developed countries. A number of international legal instruments and transplant societies define, condemn, and criminalise these practices and have issued statements related to organ commercialism. In contrast, limited attention has been paid to illicit and unethical activities associated with the procurement and clinical use of tissues. In India, The Transplantation of Human Organs (Amendment) Act, 2011, has taken multiple measures to combat organ and tissue commerce and as a result the number of such instances seems to be on the decline. However, the fight against unethical organ procurement through the internet and the social media is challenging and requires the cooperation of global bodies. Keywords: Organ trade, Declaration of Istanbul, tissue commerce, organ transplants, transplant tourism
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Background: Era’s one of the utmost scourges is air pollution, owing to not only its impact on climate change but also its impact on public and individual’s health due to combined morbidity and mortality. Objectives: The current study was intended to monitor the air quality data from two districts of Chhattisgarh, namely Raipur and Korba, so that policymakers will be able to take corrective measures to control individual’s health‑related issues associated with polluted air. Methods: All air samples were collected from around Raipur and Korba city of Chhattisgarh and submitted to the Chester LabNet, a laboratory based in 3 Oregon, USA, for analysis. Particulate matter (PM2.5) was determined by using the gravimetry technique and used the X‑ray fluorescence 4 technique to detect the presence of heavy metals. Results: PM2.5 levels in all samples in Raipur and Korba ranged from 131.4–653.8 µg/m3 to 150.3–1699.2 µg/m3 which is 2.18–10.88 and 2.5–28.3 times higher than standards prescribed by the Ministry of Environment, Forest and Climate Change (MoEFCC) of 60 µg/m3 . Heavy metals such as silica (Si), lead (Pb), nickel (Ni), and manganese (Mn) levels were recorded higher than the standard level reported by the National Ambient Air Quality Standards in locations of Raipur and Korba, Chhattisgarh. Conclusion: Although Chhattisgarh, a state in Central India covered with 45% forest, but it is suffering from low air quality due to developing township and industrial area, which is causing a lot of commotion in the local community. At this time, the government should approach to take immediate action and measures to control air pollution and to reduce the terrible impact on the health of local citizens.
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Background: The role of BCG and MMR/Measles vaccination in reducing the burden of COVID-19 has been based on ecological data mostly. We planned this explorative pilot case-control study to understand the role of vaccination with Bacillus Calmette朑uerin (BCG) and measles administered as part of MMR vaccine on COVID 19. Methodology: A case-control study was conducted in AIIMS Patna during December 2020 and January 2021. A total of 100 COVID-19 patients confirmed by RT-PCR test were taken as cases, and for each case, age and gender-matched SARS-COV-2 negative individual was taken as control. A study tool containing a pre-tested semi-structured questionnaire was used. Results: The unadjusted odds of COVID-19 were found to be significantly higher among BCG vaccinated [1.88(1.03-4.4)] and MMR vaccinated individuals [5.06(2.34-10.90]. BCG vaccine was not found to have an independent effect on COVID-19 after adjusting for tobacco use, MMR vaccination status, unprotected contact with SARS-COV-2 positive patients, and co-morbidities. But Measles vaccine was found to independently increase the risk of COVID-19 [AOR: 4.505(1.8-11.3)]. Conclusion: BCG vaccination status was not found to be an independent predictor of COVID-19. Further studies with large sample size and better study design (cohort, randomized trials) need to be conducted.
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Introduction: Covid-19 pandemic is further spreading its leg in India. Indigenous Covishield vaccination drive was started to protect people from the disease. Objective: This observational cross sectional study was conducted to assess the morbidity and mortality pattern amongst Covishield vaccinated people Vs non-vaccinated patients of covid19. Methodology: This observation study was conducted in a dedicated covid-19 hospital. All RTPCR covid-19 patients were included. The data on vaccination against covid-19 amongst the patients was obtained, and analysed using statistical software. Results: The study population comprised of 155 cases of confirmed covid-19 patients of which 24 (15.48%) were fully vaccinated, however 41 (26.45%) and 90 (58.06%) were partially and non-vaccinated respectively. Fully vaccinated people were protected from development of severe form of disease (X2=9.57, d.f=2, p=0.0083). Mortality was significantly less amongst vaccinated group (X2=4.83, d.f=1, p= 0.028). Conclusion: Patients who are completely vaccinated with Covishield vaccine are protected from development of severe form of diseases and deaths and hence mass vaccination of Indian population to overcome the pandemic is required at the earliest.
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The COVID-19 pandemic is draw into concern as the most reproving international fitness tragedy of the century since December 2019, the era of Second World War. A new transmissible respiratory disease comes in existence in Wuhan, Hubei province, China and the World Health Organization named it as COVID-19 (corona virus disease 2019). For the quarter of 2020 the corona virus epidemic has swamp the international locations of the sector and changed the pace, material and nature of our lives. In this evaluation accompanying, we inspect some of the various social, environmental and economic issues influenced by COVID-19. The COVID-19 epidemic has ended in over 4.3 million confirmed instances and over 290,000 deaths globally. The Indian economy as with the global economy, was faced with multiple curtailment too when the pandemic emerged. Advance estimation recommend that the Indian economy is anticipate to witness real GDP augmentation of 9.2 per cent in 2021-22 after reducing in 2020-21. This implicit that overall economic activity has retrieve past the pre-epidemic levels. Social spacing, self-isolation and travel diminution have led to a less staff throughout all capitalism or economic sectors, and because of that many jobs to be bygone. Schools have closed down, and there is requirement for artefacts and products has reduced. In contrast, there requirement for medical essentials has significantly increases. In reaction to this global epidemic, we summarize the effect of COVID-19 on socio-economic condition on individual factors of the world economy and environment.
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Metformin is considered as gold standard anti-diabetic drug and is the preferred initial pharmacologic agent for most of the patients with type 2 diabetes mellitus. Metformin is cheap, widely available and safe, backed by pharmaco-epidemiological evidence of more than 60 years regular use in clinical practice. Due to its durable efficacy, once initiated, metformin will be continued as long as it is tolerated and not contraindicated. It has got additional benefits on cholesterol, liver, cardio vascular system and cancer. Recent evidence and recall of metformin extended release formulation due to detection of excess amount of cancer-causing nitrosamine impurities has created concern among health care providers and patients. Adherence to regulatory guidelines and use of approved technologies in manufacturing and quality control may help in solving the issue.
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Objective: The objective of the present study is the evaluation of the effect of the sublethal (40% and 60% of 48h LC50) binary combination (1:5 ratios) of molluscicides deltamethrin+MGK-264 on the endogenous levels of protein, amino acid and nucleic acid in different tissues of snail Lymnaea acuminata. Methods: The snails were treated with 1:5 mixtures of sub-lethal concentration of (40% and 60% of 48h LC50) deltamethrin+MGK-264 on the protein, amino acid and nucleic acid levels in gonadal, nervous and foot tissue of L. acuminata. In order to study the effect of withdrawal from treatment, the snails were first exposed to the above concentrations for 96h, after which they were transferred to freshwater. Water was changed every 24h for the next seven days, after which different biochemical parameters were estimated. Results: There was a significant change in the levels of protein (sublethal concentration of 60% of 48h LC50 after 96h) gonadal, nervous and foot tissues are 48.1, 12.1 and 14.5%, respectively, amino acid are 273, 234 and 252%, respectively, DNA are 25.1, 38.9 and 42.1%, respectively and RNA are 12.2, 30.7 and 30.5%, respectively. These changes were time and concentration-dependent. In the withdrawal experiment, the snails were treated for 96h to transfer in freshwater for 7 d, which caused significant recovery in all the biochemical parameters. Conclusion: The present study concluded that the high molluscicidal activity of deltamethrin+MGK-264 simultaneous decrease in the levels of proteins, DNA, RNA and increase in the level of amino acids.
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The disabling mental illness anxiety is gradually affecting the modern society in any age group worldwide. The searchfor novel bioactive entity from herbal origin for different disorders has become the center of attraction significantlyfrom the past few decades. Gamma-aminobutyric acid (GABA) is the primary inhibitory neurotransmitter known tobe responsible for the anxiolytic activity of most of the potent anxiolytic agents. All the available data of pongamol1-(4-methoxybenzofuran-5-yl)-3-phenylpropane-1, 3-dione (MPD) were based on natural or semi-synthetic source.The synthetic routes were using easily available source and quick, cost-effective, and high yielding process. MPD hastraditionally been acquired from natural sources mainly from the extracts of fruits of Pongamia pinnata and Pongamiaglabra, where the yield value and the yield time are the main drawbacks. Keeping in view of the above aspects in thepresent research, it was approached to synthesize and evaluate the anxiolytic potential 1-(methoxybenzofuran-5yl)-3-phenylpropane-1, 3-dione on experimental animals and docking procedure after its synthesis. The study of MPDon the gross behavior of mice showed a significant Central Nervous System (CNS) depressant effect. Furthermore,its anxiolytic activity was confirmed by observing its reduced locomotion of mice using actophotometer and elevatedplus-maze apparatus. The highest docking score was observed to be −3.22 than the diazepam (−3.21) against GammaAmino Butyric Acid-A (GABAA). The present study provides a promising anxiolytic agent, MPD, which has itspotency due to the GABAA receptor binding and causing the mitigation of the symptoms of anxiety.
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Aim: To screen wheat generations derived from cross HD2967 × Kharchia65 for two Nax loci imparting salt tolerance and background selection of the plants using polymorphic SSRs.Methodology: The study for salt tolerance was carried out on three generations, i.e., BC1F3, BC2F2 and F4, derived from the cross HD2967 × Kharchia65 in net house. Salt stress was provided at germination stage and the plants were grown to maturity. Data was recorded for various agro-morphological traits which contributed to yield. DNA isolated from young leaves of morphologically superior plants were checked for the presence of Nax1 and Nax2 genes using gene specific primers. Plants having either or both Nax loci were then subjected to polymorphic SSR markers screening for background selection of foreground selected plants. Results: On the basis of agro-morphological performance and presence of either or both Nax genes, 68 high yielding plants were selected. Out of total 178 SSR markers screened covering the whole genome uniformly (A, B and D), 31 markers were polymorphic for the parents HD2967 and Kharchia65. These polymorphic SSR markers were used to produce molecular diversity among the selected progeny plants. Cluster analysis of parents and all the three generations, showed that all the selected plants were inclined towards recurrent parent. Interpretation: This study showed that a linked marker like Nax1 and Nax2 could be a promising tool for breeding wheat with enhanced tolerance to salinity conditions. However, growth rates and biomass production provide reliable criteria for assessing the degree of salt stress and the ability of a plant to withstand it. Therefore, initial screening of seeds in the presence of salt stress provides additional advantage in directional selection. Plants selected with Nax loci, better mean performances, high heritability, and high genetic advance as 5% of mean for the studied traits could be further backcrossed with the recurrent parent to develop salt tolerant wheat lines.
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Introduction: The standard of care for treatment of cancer cervix is concurrent chemoradiation followed by brachytherapy in the majority of cases. Conventional radiotherapy with chemotherapy causes haematological toxicities which may be related to radiation to pelvic bone marrow. The present study aims to study the haematological toxicities and correlate with the mean dose to the bone marrow. Material and Methods: Retrospective data of cancer patients treated in the institute in the year 2019 was retrieved. Haematological toxicities were analyzed in terms of CTCAE criteria. Mean dose to bone marrow was calculated after the delineation in the CT scan. The correlation between haematological toxicity and mean bone marrow was done using a paired t-test for statistical significance. Results: The data of 20 patients were retrieved. Anaemia Grade, I and Grade II-IV was seen in 65% and 35% respectively. Leukopenia Grade I and Grade II-IV were seen in 85% and 15% respectively and Lymphopenia Grade I and Grade II-Iv were seen in 55% and 45% respectively. The mean dose to bone marrow did not show any statistical significance with the severity of haematological toxicity. There was no Grade II-IV toxicity of neutropenia and thrombocytopenia. Conclusion: Conventional radiotherapy can safely be practice for patients with cancer cervix with acceptable haematological toxicities.
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Background:Palliative radiotherapy offers significant relief in the huge physical distress of patients with bony metastasis. The enormous potential of conformal techniques has not been tested in palliative settings. However,the increasing life span of patients with metastatic disease demands to optimize the radiotherapy techniques to provide maximal durable symptomatic relief. Despitean increase in the utilization of the 3DCRT technique for palliative bony metastasis, the optimal beam arrangement remains unknown. Materials and Methods:Ten patients of vertebral bony metastasis were retrospectively selected and four virtual 3DCRT plans were generated for each patient. The field approaches were a single field, two fields, three fields and five field approaches. For PTV, D90, D50, Dmean, Conformity index (CI) were evaluated.Dmean was evaluated for the esophagus, bowel, kidneys, and combined lungs. Dose-volume histograms were computed for the various treatment plans and compared. Statistical analysis was done by ANOVA test. Results:A total of forty radiotherapy plans were generated. PTV parameters were significantly better with two field plans over one field plans in terms of D90 (p= 0.002), D50 (p= 0.02), Dmean(p=0.0009). Dmeanwassignificantly better with three field approach compared to two field approach (p=0.0006). The Dmeanwas significantly increased for organs at risk in two fields and three field plans.Five field approach did not showan advantage in terms of dosimetry of PTV but there was a significant rise in the dose to Organs at risk (OAR’s). Conclusion:The three field plans showed better dose distribution to the PTV with an acceptable increase in the dose to OAR’s.
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Background: Coronavirus (CoV) infection has become a pandemic worldwide for February 2020. The infection rate has beenincreasing in India also which prompted the Government to implement countrywide lockdown.Aims and Objectives: The main objective of our study is to evaluate risk factors predisposing the patients to COVID-19 infection.Methods: This is a single center prospective observational study done during April and May 2020, where we have collectedall demographic details of total 59 COVID-19 patients admitted to the intensive care unit or general ward in our institute. Wehave evaluated the detailed history of these patients for risk factors such as age, gender, smoking, alcohol exposure, diabetesmellitus, hypertension, and cardiovascular disease and studied their association with COVID-19.Results: In our study, we have found the mean age of presentation to be 51 years and males with 64.4% are more infectedthan females. Diabetics with 32% is the most common risk factor followed by hypertension with 20.3%. Alcohol is next only tohypertension with 12% and smoking comprising 10% of the population studied.Conclusion: Elderly male population, diabetes, and hypertension pose a greater risk for CoV severe acute respiratory syndromecoronavirus 2 infection in our population.