A rare case of multiple visceral vascular variations around the kidneys: morphological and clinical aspects / Um caso raro de múltiplas variações vasculares viscerais ao redor dos rins: aspectos morfológicos e clínicos

Abstract Knowledge of the anatomical variations of the visceral branches of the abdominal aorta is important information for planning any surgeries in the region. We present here a rare constellation of variations of visceral vessels around the kidneys with a brief review of the recent literature. On the right side, an accessory renal artery was observed originating just distal to the main renal artery. The middle suprarenal artery was absent on the right side and there were two inferior suprarenal arteries originating from a branch of the main right renal artery. On the left side, the testicular artery had an arched course anterior to the left renal vein mimicking an unusual variety of nutcracker phenomenon. The right kidney was drained by two renal veins into the inferior vena cava. Knowledge of the coexistence of such complex anatomical variations might be helpful for clinicians during diagnostic and therapeutic procedures.

Resumo O conhecimento das variações anatômicas dos ramos viscerais da aorta abdominal é uma informação importante para o planejamento de qualquer cirurgia nessa região. Neste relato, apresentamos um raro conjunto de variações de vasos viscerais ao redor dos rins, bem como uma breve revisão da literatura recente. No lado direito, foi observada uma artéria renal acessória originando-se distal à artéria renal principal. Não havia artéria suprarrenal média no lado direito, e havia duas artérias suprarrenais inferiores originando-se de um ramo da artéria renal direita. No lado esquerdo, a artéria testicular apresentava um curso arqueado anterior à veia renal esquerda, simulando uma variedade incomum do fenômeno do quebra-nozes. O rim direito era drenado por duas veias renais para a veia cava inferior. O conhecimento da coexistência de tais variações anatômicas complexas pode ser útil para os clínicos durante os procedimentos diagnósticos e terapêuticos.

Minimal Intubating Dose of Succinylcholine: A Comparative Study of 0.4, 0.5 and 0.6 mg/kg Dose

Muscle relaxants are integral part of modern balanced anesthesia and succinylcholine, a depolarizing drug, is in use despite its adverse effects. The excellent intubating condition, fastest onset and shortest duration of action make it an excellent choice for anesthesiologists. The conventional dose of 1.5-2 mg/kg is commonly used for obtaining relaxation for intubation. This study was conducted with much smaller dose of succinylcholine as 0.4, 0.5 and 0.6 mg/kg to evaluate the acceptable intubating dose at 60 seconds, which was unlikely to have any untoward/side effects.

Costing analysis of an information & communications technology-enabled primary healthcare facility in India

Background & objectives: Information and communications technology (ICT) has often been endorsed as an effective tool to improve primary healthcare. However, evidence on the cost of ICT-enabled primary health centre (PHC) is lacking. The present study aimed at estimating the costs for customization and implementation of an integrated health information system for primary healthcare at a public sector urban primary healthcare facility in Chandigarh. Methods: We undertook economic costing of an ICT-enabled PHC based on health system perspective and bottom-up costing. All the resources used for the provision of ICT-enabled PHC, capital and recurrent, were identified, measured and valued. The capital items were annualized over their estimated life using a discount rate of 3 per cent. A sensitivity analysis was undertaken to assess the effect of parameter uncertainties. Finally, we assessed the cost of scaling up ICT-enabled PHC at the state level. Results: The estimated overall annual cost of delivering health services through PHC in the public sector was ? 7.88 million. The additional economic cost of ICT was ? 1.39 million i.e. 17.7 per cent over and above a non-ICT PHC cost. In a PHC with ICT, the cost per capita increased by ? 56. On scaling up to the state level (with 400 PHCs), the economic cost of ICT was estimated to be ? 0.47 million per year per PHC, which equates to approximately six per cent expenditure over and above the economic cost of a regular PHC. Interpretation & conclusions: Implementing a model of information technology-PHC in a state of India would require an augmentation of cost by about six per cent, which seems fiscally sustainable. However, contextual factors related to the availability of infrastructure, human resources and medical supplies for delivering quality PHC services will also need to be considered.

A Randomized Controlled Trial to Assess the Effects of Oral Alkali Therapy in Patients with Diabetic Kidney Disease

Background: To analyze the effects of oral alkali therapy on renal function, nutritional status and bone density in patients of diabetic kidney disease. Material & Methods: A randomized controlled trial was conducted on 60 patients of age>18 years with diabetic kidney disease who were not on dialysis and had plasma bicarbonate levels between 16 and 20 mmol/l. Patients were randomly divided into two groups: Test group (n=30) which received oral alkali therapy as sodium bicarbonate and control group (n=30) who did not receive oral alkali therapy. The patients were followed for 12 months to compare the improvement. Results: In comparison to controls, test group showed a significant improvement in the Hb (0.7 vs. 0.25, P =0.003), significantly less decrease in eGFR (-2.25 vs. -2.9, P=0.049), non-significant less increase in creatinine (-0.26 ± 0.4 vs. -0.43 ± 0.33, P=0.09), significant improvement in bicarbonate levels (7.5 vs. 1, p<0.0001), significant restoration of albumin (0.32 vs. 0.05, P<.0001), significant fall in iPTH levels (50 vs. 25, p=0.007) and ALP levels (32 vs. 12, p=0.015). Bone density (0.28 ± 0.17 vs. 0.01 ± 0.13, P<.0001) and clinical well-being VAS scores improved significantly among the cases (9.83 ± 5.65 vs. -1.67 ± 7.11, P<.0001). Conclusion: In conclusion, oral alkali therapy slows the rate of decline of renal function and the development of end stage renal disease in patients with advanced stages of CKD. This cheap and simple strategy, which is in line with current renal consensus documents, also improves the nutritional status of patients and bone density.

Comparison of prevention of parent-to-child HIV transmission programme & national biennial HIV sentinel surveillance data for tracking HIV epidemic in India

Background & objectives: HIV sentinel surveillance (HSS) among antenatal women in India has been used to track the epidemic for many years. However, reliable tracking at the local level is not possible as ANC sentinel sites are limited in number and cover a smaller sample size at each site. Prevention of parent-to-child-transmission (PPTCT) programme data has a potential advantage due to better geographical coverage, which could provide more precise HIV case estimates; therefore, we compared HSS ANC data with PPTCT programme data for HIV tracking. Methods: Out of the 499 surveillance sites, where HSS and PPTCT programme was being conducted in 2015, 210 sites (140 urban and 70 rural) were selected using a stratified random sampling method. HSS (n=72,981) and PPTCT (n=112,832) data records were linked confidentially. The sociodemographic characteristics of HSS and PPTCT attendees were compared. HIV prevalence from HSS ANC was compared with the PPTCT programme data using Chi-square test. State- and site-level correlation of HIV prevalence was also done. Concordance between HSS and PPTCT HIV positivity was estimated using kappa statistics. Results: The age distribution of HSS and PPTCT attendees was similar (range: 23 to 27 yr); however, HSS ANC participants were better educated, whereas PPTCT recorded a higher proportion of homemakers. The correlation of HIV prevalence between HSS and PPTCT was high (r=0.9) at the State level and moderate at the site level (r=0.7). The HIV positivity agreement between HSS ANC and PPTCT was good (kappa=0.633). A similar prevalence was reported across 26 States, whereas PPTCT had a significantly lower prevalence than HSS in three States where PPTCT coverage was low. Overall HIV prevalence was 0.31 per cent in HSS and 0.22 per cent in PPTCT (P<0.001). Interpretation & conclusions: High-quality PPTCT programme data can provide reliable HIV trends in India. An operational framework for PPTCT-based surveillance should be pilot-tested in a phased manner before replacing HSS with PPTCT.

The outcome of primary percutaneous coronary intervention in patients with stent thrombosis

Background: Primary percutaneous coronary intervention (PCI) is a recommended management strategy for patients with de novo ST-segment elevation myocardial infarction (STEMI). Still, the efficacy of primary PCI in-stent thrombosis (ST) induced STEMI is unclear. The aim was to assess the clinical characteristics and the in-hospital outcomes of patients undergoing primary PCI for STEMI caused by acute, sub-acute, or late ST. Methods: A sample of hundred consecutive patients who presented with STEMI due to ST were included in this study. The angiographic evidence of a flow-limiting thrombus or total vessel occlusion (thrombolysis in myocardial infarction (TIMI) flow grade 0 to II) at the site of the previous stent implant was taken as ST. Primary PCI was performed, and all enrolled patients and in-hospital mortality were observed. Results: Male patients were 69, and the mean age was 58.9 ± 7.78 years. ST was categorized as acute in 40 patients, sub-acute in 53, and late in the remaining seven patients. Killip class III/IV was observed in 45 patients. Dissection was observed in 25, under deployment in 74, and/or malposition in 24 patients. Thrombus aspiration was performed in 97, plain old balloon angioplasty in 76, and stenting in 22 patients. Final TIMI III flow was achieved in 32 patients. During a mean hospital stay of 4.93 ± 2.46 days, the mortality rate was 27%. Conclusion: In-hospital mortality after primary PCI was observed in more than 1/4th of the patients with STEMI due to ST undergoing primary PCI

Fish hook technique for nucleus management in manual small-incision cataract surgery: An Overview

Manual small-incision cataract surgery (MSICS) preserves its utility as a cost-effective and efficient strategy for mitigating cataract-associated blindness. Numerous techniques of nucleus delivery in MSICS have been described in the literature. The fish hook technique of nucleus extraction was advocated in 1997 and has been popular for high-volume surgery in limited pockets of the world. This article describes in detail the steps involved in the construction of a fish hook, tips of nucleus extraction with the help of a fish hook, and the pros and cons of fish hook-based MSICS through text, diagram, and video supplement.

Efficacy of Motivational Interviewing and Brief Interventions on tobacco use among healthy adults: A systematic review of randomized controlled trials / Eficacia de la entrevista motivacional y de las intervenciones breves sobre el consumo de tabaco en adultos sanos: Una revisión sistemática de ensayos controlados aleatorizados / Descriptores: entrevista motivacional; cese del uso de tabaco; uso de tabaco; adulto. Eficácia da entrevista motivacional e intervenções breves sobre o uso de tabaco em adultos saudáveis: uma revisão sistemática de ensaios clínicos randomizados

Objective.To assess the effectiveness of a brief intervention and motivational interviewing in reducing the use of different tobacco-related products in adults Methods. Forthis systematic review, PubMed, Web of Science, and PsychINFO databases were electronically searched for randomized controlled trials on the effect of a brief intervention and / or motivational interview on tobacco reduction among healthy adults published between January 1, 2011 to January 1, 2021. Data from eligible studies were extracted and analyzed. CONSORT guidelines were used to assess the quality of the studies by two reviewers for the included studies. The titles and abstracts of the search results were screened and reviewed by two independent reviewers for eligibility criteria per the inclusion and exclusion criteria. Cochrane review criteria were used to assess the risk of bias in included studies. Results. A total of 12 studies were included in the final data extraction of 1406 studies. The brief intervention and motivational interviewing showed varied effects on tobacco use reduction among adults at different follow-ups. Seven of the 12 studies (58.3%) reported a beneficial impact on reducing tobacco use. Pieces of evidence on biochemical estimation on tobacco reduction are limited compared to self-reports, and varied results on quitting and tobacco cessation with different follow-ups. Conclusion. The current evidence supports the effectiveness of a brief intervention and motivational interviewing to quit tobacco use. Still, it suggests using more biochemical markers as outcome measures to reach an intervention-specific decision. While more initiatives to train nurses in providing non-pharmacological nursing interventions, including brief interventions, are recommended to help people quit smoking.

Objetivo. Evaluar la eficacia de una intervención breve y de la entrevista motivacional para reducir el consumo de diferentes productos relacionados con el tabaco en adultos. Métodos. Para esta revisión sistemática, se buscaron en las bases de datos PubMed, Web of Science y PsychINFO ensayos controlados aleatorizados sobre el efecto de una intervención breve y/o una entrevista motivacional en la reducción del consumo de tabaco entre adultos sanos, que hubieran sido publicados entre el 1 de enero de 2011 y el 1 de enero de 2021. Los títulos y los resúmenes de los artículos incluidos fueron evaluados por dos revisores independientes para determinar los criterios de elegibilidad, se analizó la calidad de los estudios con la guía CONSORT y se utilizaron los criterios de Cochrane para evaluar el riesgo de sesgo.Resultados.Se incluyeron un total de 12 de los 1406 estudios que arrojó la búsqueda. La intervención breve y la entrevista motivacional mostraron efectos variados en la reducción del consumo de tabaco entre los adultos en diferentes seguimientos. Siete de los 12 estudios (58.3%) informaron de un impacto beneficioso en la reducción del consumo de tabaco. La utilización de indicadores bioquímicos de la reducción del consumo de tabaco fueron limitados en comparación con los autoinformes. Los resultados sobre el abandono y la cesación del tabaco fueron variados con diferentes seguimientos. Conclusión.La evidencia apoyó la efectividad de una intervención breve y de la entrevista motivacional para la cesación del consumo de tabaco. Sin embargo, se sugiere realizar más estudios con marcadores bioquímicos como medidas de resultado para llegar a una decisión específica de la intervención. Se recomienda formar a los enfermeros en la realización de intervenciones de enfermería no farmacológicas, incluidas las intervenciones breves, para ayudar a las personas a dejar de fumar.

Objetivo. Avaliar a eficácia de uma intervenção breve e entrevista motivacional na redução do uso de diferentes produtos relacionados ao tabaco em adultos. Métodos.Para esta revisão sistemática, se buscou nas bases de PubMed, Web of Science e PsychINFO ensaios controlados aleatórios sobre o efeito de uma breve intervenção e/ou entrevista motivacional na redução do uso de tabaco entre adultos saudáveis, publicados entre 1º de janeiro de 2011 e 1º de janeiro de 2021. Os títulos e resumos dos artigos incluídos foram avaliados por dois revisores independentes para critérios de elegibilidade, a qualidade do estudo foi avaliada usando a diretriz CONSORT e os critérios Cochrane foram usados para avaliar o risco de viés. Resultados. Um total de 12 dos 1.406 estudos retornados pela busca foram incluídos. Intervenção breve e entrevista motivacional mostraram efeitos mistos na redução do uso de tabaco entre adultos em diferentes acompanhamentos. Sete dos 12 estudos (58.3%) relataram um impacto benéfico na redução do uso de tabaco. O uso de indicadores bioquímicos de redução do uso de tabaco foi limitado em relação ao autorrelato. Os resultados sobre parar de fumar e parar de fumar foram variados com diferentes seguimentos. Conclusão. As evidências apoiaram a eficácia de uma intervenção breve e entrevista motivacional para a cessação do uso do tabaco. No entanto, mais estudos com marcadores bioquímicos como medidas de resultados são sugeridos para chegar a uma decisão de intervenção específica. Recomenda-se que os enfermeiros sejam treinados na execução de intervenções de enfermagem não farmacológicas, incluindo intervenções breves, para ajudar as pessoas a parar de fumar.

Retino-Renal Dissociation in Type 2 Diabetes Mellitus: An Observational Cross Sectional Study at a Tertiary Care Center of Sub-Himalayan Region

Background: Dysregulated serum levels of Mannan binding lectin (MBL) has a probable role in Systemic Lupus Erythematosus (SLE) pathogenesis. Objective: To evaluate the association between serum MBL levels in SLE patients from western India with the severity of disease Methods: SLE patients (n=70) from Western India were included. Based on MBL levels, patients were classified into four categories, viz. low (<100 ng/ml), mild (100-500 ng/ml), moderate (500-1000 ng/ml) and high (>1000 ng/ml). Correlation of serum MBL levels with disease severity was assessed using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). MBL levels and circulating immune complex levels were detected by ELISA. C3, C4 and CRP levels were detected by nephelometer. Results: Serum MBL levels of SLE patients (1954 ± 202.4 ng/ml) was lower than that of healthy controls (2388 ± 205.0 ng/ ml). There was no significant correlation between MBL levels with severity of SLE on the basis of ACR criteria and SLEDAI scores (p> 0.05). No significant difference was observed among MBL levels and SLE patients with (1847 ± 246.7) or without (1900 ± 246.8) Lupus Nephritis. SLE patients without infections (n= 33) had low MBL levels (1700 ± 301.0 ng/ ml) as compared with SLE patients with infection (n= 37) (2189 ± 284.6 ng/ ml) (p=0.30) Conclusion: Present study indicated that low MBL levels were not associated with disease severity, haematological manifestations and infections among SLE patients from Western India.

Renal Hypoplasia: Case Literature Review

Introduction: Congenital anomalies of kidney and urinary tract (CAKUT) presents a broad range of disorders including abnormal renal parenchymal development, disrupted parenchymal development, abnormalities of lower urinary tract, urinary collecting system. The knowledge of these anomalies will help the clinicians and surgeons during the procedures of kidney. The purpose of this article is to present one of the cases of renal hypoplasia and the review that highlights renal hypoplasia cases. Methodology: A vertical incision has been made in midline from xiphoid process to pubic symphysis encircling the umbilicus, another incision from pubic symphysis laterally up to the anterior superior iliac tubercle along the iliac crest to expose the abdominal cavity. Details of the position suprarenal gland and the upper poles of the kidneys and external appearance of kidneys in situ were noted. The arrangement of the attached structures such as the hilum with structures passing through, ureter, bladder, abdominal aorta and the inferior vena cava were also noted and recorded. Observation and Result: The size of the left kidney was found small in comparison to right kidney. Coronal section of left kidney also showed a smaller number of renal pyramids, major calyces and minor calyces. Conclusion: The knowledge of anatomical variations of urinary system has a significant role for clinicians and surgeons for diagnosing diseases including congenital anomalies, radiological interpretations, procedures, surgical interventions and management of clinical conditions.

Association of Birth Weight with Risk Factors of Cardiovascular Diseases: A Birth Cohort Analysis from a Rural Area of Northern India

Background: Fetal origin of cardiovascular diseases (CVD) hypothesis has been explored mostly in retrospective studies. Objectives: A prospective study was conducted to find the association of birth weight with CVD risk factors. Methods: A cohort of 243 babies born in 1992–1993 in ten villages of Raipur Rani Block in India, were followed?up in 2016–2017. WHO STEPS methods were used to assess the risk factors of CVDs. A total of 213 (87.8%) participants were examined; blood samples were collected from 207. Multivariable regression analysis was done to adjust for the confounding variables. Results: Study participants were 22–24 year old, 27.7% were exposed to tobacco and 24.8% consumed alcohol, 3.3% were taking >5 servings of fruits and vegetables per day, 35.7% were physically inactive, 28.6% were overweight (body mass index [BMI] ?23 kg/m2 ), 12.2% had hypertension, 16% had high cholesterol (?200 mg/dl), 16.4% had insulin resistance (IR) (Homeostatic Model Assessment?IR >3), and 20.7% were born with low birth weight (<2.5 kg). Multivariable regression analysis revealed inverse relationship between birth weight and systolic blood pressure (regression coefficient ?3.72 mmHg, 95% confidence interval ?7.249; ?0.183, P < 0.05). Conclusion: Birth weight has inverse relationship with blood pressure. Effect of birth weight on CVDs should also be studied in future follow?ups.

Primary peripheral T-cell lymphoma of the cervix with mononeuritis multiplex: an unusual case presentation

Peripheral neuropathy (PN) is characterized by the injury to the peripheral nervous system of varied etiology. Lymphoma is one of the etiologies of PN, presenting various neurological manifestations. Neuropathy associated with peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS) is unusual and fewer cases are documented in the literature. In addition, PTCL, NOS is extremely rare as primary in the female genital tract, especially uterine cervix, and exhibits aggressive clinical course with poor therapy response. We hereby describe a 47-year-old female who presented with fever and chills for 15 days. Clinical examination revealed left-sided lower motor neuron type of facial nerve palsy with Bell's phenomenon. Nerve conduction study of all four limbs illustrated asymmetrical axonal neuropathy (motor > sensory), suggesting mononeuritis multiplex. She developed vaginal bleeding during her hospital stay. Pelvic examination and imaging revealed a 4x3cm polypoidal mass on the posterior lip of the cervix, which was excised and diagnosed as extranodal primary PTCL, NOS based on morphology, immunohistochemistry, and in-situ hybridization findings. Besides, the cerebrospinal fluid (CSF) was infiltrated by the lymphoma cells, detected on cell block preparation. The patient succumbed to her illness within one week despite best efforts and the commencement of chemotherapy. No consent was obtainable for nerve biopsy and autopsy. Thus, we report an extremely rare case of primary extranodal PTCL, NOS of the uterine cervix with unusual presentation of mononeuritis multiplex. Further, we discussed the differentials of PTCL, NOS at this extranodal site.

A study of Mental Health Status in Healthcare Workers posted in a dedicated COVID-19 Hospital

Background: The massive toll due to COVID-19 has resulted in stretching of resources of healthcare systems and has led to unique demands on healthcare workers (HCWs) that are not seen in usual practice, which predispose them to mental health problems. The aim of the study was to assess mental health status in healthcare workers posted in COVID hospital as Mental health issues may impact decision making among HCWs, leading to medical errors and may also impact wellbeing in the long term. Methodology: This was a cross-sectional study. 799 HCWs posted in the COVID-19 wing of a tertiary care hospital were studied. Socio-demographic details were recorded and a Gujarati version of GHQ-28 was applied. A total score of ? 4 on GHQ-28 was considered indicative of ‘caseness’ or ‘psychiatric morbidity’. Association of outcomes like total GHQ-28 score, and responses on individual items of GHQ indicative of fatigue, sleep disturbances, stress, irritability, anxiety and others with variables like age, gender, profession, years of experience, marital status and family type was assessed. Results: 40 individuals (5%) reported at least one of the symptoms. The most commonly reported symptom was sleep disturbance, reported by 38 participants (4.75%), followed by stress in 34 participants (4.25%), fatigue in 29 participants (3.62%) and anxiety in 24 (3.00%). Decision-making problems, hopelessness, death wishes/suicidal ideation were rare. Conclusion: Age > 45 years was a significant predictor for GHQ-28 total score being ?4 and stress, experience > 5 years was statistically significantly associated with sleep disturbance, and being female was a significant predictor for fatigue.

Neo-adjuvant chemotherapy followed by either continuous hyper-fractionated accelerated radiation therapy week-end less or conventional chemo-radiotherapy in locally advanced NSCLC-A randomised prospective single institute study

Context: Better locoregional control and increased overall survival by continuous hyper fractionated accelerated radiotherapy have been shown in unresectable nonsmall cell lung carcinoma (NSCLC). Dose escalation and neoadjuvant chemotherapy (NACT) along with continuous hyperfractionated accelerated radiotherapy week end-less (CHARTWEL) were also tried for improved survival. In this present study, we compared the results of NACT followed by CHARTWEL against NACT followed by conventional concurrent chemo-radiation therapy. Aims: The aim of this study is to compare the locoregional control and toxicities in NSCLC Stage IIIA and B in both arms. Settings and Design: Randomized, prospective single-institutional study with a study population comprising all locally advanced unresectable NSCLC patients enrolled in 2014 at our institute. Subjects and Methods: All enrolled patients were randomized into two arms-CHARTWEL and concomitant chemo-radiotherapy (CCRT), after three weeks of the fourth cycle of NACT. In CHARTWEL arm 30 patients received two-dimensional radiotherapy (RT) 58.5 Gy/39 fr/2.5 weeks while in CCRT arm 30 received 66 Gy/33 fr/6.5 weeks. Disease response was evaluated at 6 months and toxicity assessment during and after treatment completion. Data were analyzed using tools such as percentage, mean, Chi-square test and P value. Chi-square and P value was calculated by statistical online software (http://quantpsy.org). Results: 28% of patients in study arm and 20% in control arm had complete response at 6 months after RT. Locoregional disease control was observed in 44% in study arm and 32% in control arm of patients. There was no statistical difference in grades of toxicities or overall survival (OS)/disease-free survival except persistent esophagitis Grade III seen in two patients of study arm. Conclusions: Study suggests that CHARTWEL in combination with NACT is an effective strategy to treat patients with locally advanced lung cancer with the advantage of a smaller dose and shorter duration. Although large multivariate studies still needed

Clinico- Epidemiological Profile of Acute Appendicitis in a Tertiary Care Hospital in North India

Introduction: Acute appendicitis is one of the most commonsurgical emergencies. Accurate diagnosis of acute appendicitisneeds careful history, and physical evaluation, as the diagnosisis primarily clinical.Material and methods: A cross sectional study was done in50 patients who underwent emergency appendicectomy foracute appendicitis in a medical college hospital in Shimla.The aim was to study the clinical profile of patients with acuteappendicitis and compare it with the existing literature.Results: Mean age of patients was 26.48 (± 12.28) years.Out of 50 patients, 29 (58%) were males and 21 (42%) werefemales, so male predominance was seen in the present study.Most common complaints were pain in the right iliac fossa(100%), nausea and vomiting (82%), anorexia (80%), andmigration of pain (70%). Tenderness in right iliac fossa waspresent in all patients in our study (100%), while reboundtenderness (70%), guarding (64%), rigidity (6%), Rovsingsign (36%), Psoas sign (46%), Obturator sign (22%), andDunphy sign (60%), respectively.Conclusions: Acute appendicitis is more common amongmales than females, and between 10- 30 yrs of age. Themost common presenting features were pain abdomen,anorexia, nausea, and vomiting. The most common signs weretenderness, rebound tenderness and guarding. The rate ofaccuracy of clinical examination was 86%.

Phenotypic Time Trend in Performance Evaluation of Dahlem Red Chicken under Intensive Management in Himachal Pradesh

A study was conducted to evaluate the production performance of Dahlem Red chicken over three consecutive generations maintained in intensive system. Dahlem Red birds were initially procured from CPDO Chandigarh and further produced through selective breeding. Performance traits evaluated were growth (day old chick weight, 4th week body weight (BW), 8th week BW, 12th week BW, 20th week BW and 40th week BW), age at sexual maturity, hen housed egg production (HHEP), hen day egg production (HDEP) and survivor egg production (SEP) at 40, 52 and 72 weeks of age and egg weight at 28, 40 and 52 weeks of age. Analysis revealed positive phenotypic trend in 4 week (17.58 g), 8 week (56.35 g), 12 week body weight (133.5 g), age at first egg (5.5 days) and age at 25% HHEP (2.0 days). The hen housed and hen day egg production at 40, 52 and 72 weeks revealed positive phenotypic trend of 4.79 and 1.93, 15.83 and 8.31, 31.6 and 13.98 eggs respectively. Further, survivor egg production also showed positive trend estimates at 40 and 52 weeks. Declining trends were observed in SEP at 72 week, day old chick weight (-0.89 g), 20 week BW (-37.99 g), 40 week BW (-141.2 g) and egg weight at 28 week (-1.7 g), 40 week (-3.3 g) and 52 week (-2.3 g). The results indicated the effectiveness of the selection along with improved management for bringing improvement in production traits in successive generations

In silico analysis of chili encoded miRNAs targeting Chili leaf curl begomovirus and its associated satellite

Chili leaf curl virus (ChiLCV), a member of the Geminiviridae family (Genus: Begomovirus), is one of themost destructive plant viruses. Micro (mi) RNAs (miRNAs) are the endogenous non-coding small RNAsthat play significant roles in plant growth and stress resistance by degrading targeted mRNA or repressingmRNA translation. Computational methods have identified numerous miRNAs in many plant species, whereasthere is no report of chili miRNAs targeting essential genes of the ChiLCV genome and associated satellites.In this study, we have predicted chili-encoded miRNAs that could be used for silencing against chili leafcurl virus (Accession no. MF737343) infection. We predicted several potential mir-miRNAs, exhibited highcomplementarities with V1 coat protein and C1 (Rep) genes of ChiLCV. Other overlapping genes, such as V2,C2, and C3 were also targeted by mir-miRNAs.

Comparative Evaluation of Functional and Anatomical Outcome of Strabismus Surgery Performed Before Completion of Amblyopia Therapy and After Completion of Amblyopia Therapy in Children Under Nine Years of Age

Background: To determine timing of strabismus surgery, is it better to do strabismus surgery before completion of Amblyopia therapy or after completion of amblyopia therapy. Methods: 40 children were taken for this study. These children were divided into two groups of 20 each. Amblyopia was fully treated in group A and in group B children underwent surgery before full treatment of amblyopia in the form of occlusion therapy. Motor success (10 PD of orthophoria) was assessed after three months of surgery and at the child’s most recent visit. Sensory success was assessed by comparing the frequency of detectable stereoacuity. Results: There was no significant difference in motor success (65% vs 80%) and sensory success (65% vs 75%) whether amblyopia was fully treated or partially treated. Conclusion: It is not mandatory to treat ambloypia prior to surgery and amblyopia therapy can be continued post operatively.

Study of indications, complications and outcomes of neonatal transport by a skilled team

Background: A skilled transport team is an essential requirement for safe and effective neonatal transport. The transport team of this level III NICU in Chennai performs a considerable number of transports every year and a need was felt to study the indications, complications and outcomes of transport.Methods: Prospective Descriptive study of neonatal transports conducted 18 months Patients were divided into 2 main groups based on transport Duration: Short (?1hr) and Long (>1hr) transport groups. TRIPS (Transport risk index of physiologic stability) score, a risk- weighted validated neonatal transport was used as a practical system for assessing infant transport careResults: During the study period 210 transports were performed from 12 cities and towns. 60% transports were of short duration. Respiratory causes were the most common indications (43.8%) followed by CNS causes (19.5%). 44.3%(93) patients required ventilation during the transport process. Overall, there was improvement in mean TRIPS 2 score compared to TRIPS 1 in all groups of patients (Short, Prolonged, Survivors and Non-survivors). Total mortality of transported group was 31 patients (14.8%). (Including 02 patients who died enroute). There were non-significant differences in 7 day mortality (7.6% vs 8.4%) and total mortality (13.9% vs 13.4%) between the groups. Complications that occurred during transport included hyperglycemia, prolonged CFT, hypothermia, accidental extubation enroute, hypoglycemia, hyperthermia, Hypotension, and persistent Hypoxia.Conclusions: It appears, that overall, duration of transport does not adversely affect outcome. Transport Team should be able to intubate and ventilate the baby and diagnose and manage complications like hypothermia, shock and hypoglycemia at referring hospital and enroute.

Loneliness, sociability and depression in old age home elderly

Background: Increasing elderly population became a big concern to health professionals. Loneliness, lack of socialization and depression is quite frequently reported in elderly population. Lack of evidence on impact of socialization and loneliness on depression necessitate this survey. The current work focused on level of socialization, loneliness and depression among elderly residing in old age homes.Methods: The cross-sectional survey includes 100 purposively selected elderly from selected old age homes, Uttarakhand. Elderly were interviewed by using University of California, Los Angeles (UCLA) Loneliness scale, Geriatric depression scale (GDS) and Eysenck personality inventory (EPI) sociability subscale of extroversion. Appropriate statistics was applied to generate results.Results: Findings revealed a significant relationship of loneliness with depression (r=-0.740, p<0.01) and sociability (r=0.195, p<0.01). Similarly, sociability and depression were found dependent on each other (r=-0.354, p<0.01) in elderly.Conclusions: Elderly residing in old age homes need due attention and care to get rid of these silent psychological problems. Timely medical care and measures to improve socialization may help to anticipate mortality and morbidity and protect the vulnerable population.