Distance and near vision changes after intravitreal anti-vascular endothelial growth factor injection in eyes with center-involving diabetic macular edema

Purpose: To elucidate distance and near vision changes after intravitreal injections in center?involving diabetic macular edema (CIDME) in phakic and pseudophakic groups. Methods: A retrospective study was done on 148 eyes (72 phakic and 76 pseudophakic) with center?involving DME. All eyes were treated with intravitreal anti?vascular endothelial growth factor (VEGF) injection. All patients underwent distance best?corrected visual acuity (BCVA) testing, near BCVA testing, dilated fundus examination, and optical coherence tomography (OCT) at baseline and follow?up visits. Eyes that could not improve after the first injection were given 2nd, 3rd, and more injections in the subsequent visits. Results: On follow?up, post injections in the phakic group (n = 72), there were 65 eyes (90.3%) with stable/improved near vision and 59 eyes (81.9%) with stable/improved distance vision, whereas in the pseudophakic group (n = 76), 63 eyes (82.9%) and 60 eyes (78.9%), respectively. Both in phakic and pseudophakic eyes, 7.7%–13% of the cohort showed only near vision improvement. Conclusion: In DME, besides the changes in distance vision, there are also changes in near vision. These changes should be taken into account while determining the response to anti?VEGF in DME treatment.

Quantitative estimation of Carthamin and Carthamidin from the Florets C. tinctorius L., (Safflower Florets)

Natural colorants derived fom plant materials have gained increasing popularity due to their non toxic nature. pigment extraction from the florets is normally done by Soxhlet extraction, maceration, and hydro distillation are conventional methods that have been widely used in industry and laboratory .phytochemical analysis of safflower florets revealed the plant presence of high amount of Carthamin and carthamidin.

Short-term outcomes of micropulse transscleral cyclophotocoagulation as a primary versus additional therapy in eyes with uncontrolled glaucoma

Purpose: To study the safety and efficacy outcomes of Micropulse Transscleral Cyclophotocoagulation (MP?TSCPC) as a primary versus additional therapy in eyes with uncontrolled glaucoma. Methods: This was a prospective, interventional, comparative study. All patients with advanced and refractory glaucoma treated with MP?TSCPC from April 2020 to December 2020 were recruited in this study. Results: A total of 77 eyes of 77 patients were analyzed. Group A (n = 33), included patients with advanced glaucoma at high risk for invasive surgery, who underwent MP?TSCPC as the primary intervention, and group B (n = 44) included patients who had undergone previous surgical intervention and MP?TSCPC was used additionally to control the intraocular pressure (IOP). Mean IOP and mean number of antiglaucoma medications were 34.06 (13.9) mmHg and 3.64 (0.7), respectively, in group A and 35.61 (11.5) mmHg and 3.73 (0.9), respectively, in Group B. Postoperatively, the mean IOP and percentage of IOP reduction were significantly lower at 1, 3, and 6 months, that is, 20.78 (32%), 22.07 (30%), and 19.09 (37%), respectively, in group A and 23.68 (35%), 19.50 (44%), and 19.61 (42%), respectively, in group B, but there was no difference between the groups at all visits. Postoperative need for ocular hypotensive drugs did not differ in group A (P = 0.231); however, it was significantly lower in group B (P = 0.027). Group A had 87%, 77%, and 74% success rates at 1, 3, and 6 months, respectively, whereas group B had 91%, 86%, and 77% success rates at 1, 3, and 6 months, respectively. Postoperative complications and intervention did not reveal any statistical difference between the two groups. Conclusion: MP?TSCPC may be considered as a temporizing measure both as a primary or as an additional intervention to control the IOP in eyes with refractory and advanced glaucoma that have a high risk of vision?threatening complications with invasive surgery.

Study of Clinico-mycological profile of onychomycosis at a tertiary carehospital

Introduction: Onychomycosis (OM) is a common nail disorder caused by dermatophytes, non-dermatophyte moulds and yeasts. The increased prevalence of OM along with the wide range of associated fungi necessitates the accurate laboratory isola?on and iden?fica?on of the causa?ve fungus for op?mal management strategies. The aim of the study was to evaluate clinical, epidemiological and mycological characteris?cs of OM at a ter?ary care hospital in Karimnagar. Materials and Methods: The study was conducted at Department of Microbiology for a period of one year. 109 pa?ents clinically diagnosed as OM were subjected to detailed history, clinical examina?on and inves?ga?ons. Nail clippings and subungual debris of OM pa?ents were subjected to KOH prepara?on and culture. Isolates were iden?fied by colony characters, pigment produc?on, microscopic morphology. Results: The maximum number of OM cases belonged to the age group 21-30 years with a male preponderance. Higher incidence was noted in males (71.5%) than females (28.4%). Direct microscopy of the nail clippings in 40% KOH solu?on was posi?ve in 56.8% and culture was posi?ve in 75.2% cases. The common e?ological agent was dermatophytes (45.12% cases) followed by yeasts (34.14% and non dermatophyte molds (20.7% cases). T.rubrum was the commonest among dermatophytes and Candida albicans among the yeasts. Conclusions: Although onychomycosis is not life threatening, it can cause a significant nega?ve impact on the quality of life of infected pa?ents. Early diagnosis and treatment is important to prevent distor?on of the nails which can prevent loss of working efficiency of the commonly affected popula?on.

Chronic musculoskeletal pain in older people

Musculoskeletal pain is a common and debilitating symptom in older adults. However, its importance is often underestimated. In this review article, we discuss its proper evaluation and management. Pain evaluation includes detailed history taking, physical examination, imaging, and laboratory investigations. Management of musculoskeletal pain requires a multidomain approach including nonpharmacological, pharmacological, and surgical modalities. A step-wise approach recommended by the World Health Organization can be used for pain management. Common musculoskeletal conditions causing pain are osteoarthritis, low?back pain, gout, pseudogout, rheumatoid arthritis, polymyalgia rheumatica, and fibromyalgia.

Potential of X-ray imaging to detect citrus granulation in different cultivars with progress in harvesting time

Granulation, a physiological disorder of citrus is manifested by shriveled juice sacs and internal dryness. Extractable juice in granulated tissue is drastically reduced as a consequence of gelatinization and secondary epidermis formation. Since, the defect cannot be detected externally it leads to consumer dissatisfaction and poor returns to farmers. Processing industry also faces huge economic loss due to reduction in the juice recovery from granulated fruit. In this context, here, we studied the possibility of developing an image processing algorithm through MATLAB software to detect granulation with advancement of maturity via X-ray micrographs. Fruit of eight citrus cultivars comprising of granulation susceptible and tolerant varieties harvested at four different intervals were exposed to X-rays. Voltage of 46 kV and current of 6.5 mA given to fruit for an exposure time of 320 mAs gave the best X-ray image contrasts. The developed algorithm could effectively distinguish the healthy and granulated fruit with an accuracy of 90% as validated by subsequent destructive analysis when estimated for four different harvesting dates. The imaging technique can be employed by the processors to determine the severity of granulation and to sort out fruit online which will help in saving economic losses.

Assessment of Perception about Immunization Among the Mothers of Under-Five Children at Urban Slum Area of Vijayapura City

Introduction: Immunization is one of the most cost-effective health investments worldwide. The World Health Organization (WHO) launched the expanded programme on immunization (EPI) in 1974 with the aim of immunizing children throughout the world. Objective: Assessment of perception about immunization among the mothers of under-five children at urban slum area of Vijayapura city. Methods: Cross-sectional study was conducted in Urban Field practice area of Community Medicine department among the mothers of under-five children residing permanently in the area and were interviewed regarding the perception about immunization to their children by using pre-structured proforma. Results: level of knowledge & perception was found average (around 50%). Nearly 40 to 60% of the participants agreed to the statements which signifies the immunization is very important to the child’s growth and development and should not be avoided. Conclusions: Providing mothers of under-five children with information about vaccination effectively increases the immunization coverage and was highly cost-effective also

Orthostatic hypotension: An overlooked but clinically decisive entity

Orthostatic hypotension (OH) is defined as a drop of >20 mm Hg of systolic or >10 mm Hg of diastolic blood pressure (BP) within 3 min of standing from lying position. It is a common geriatric syndrome caused by impaired orthostatic response of BP. Its clinical manifestation can range from dizziness to syncope. It is a common cause of recurrent falls and fracture in older adults. Its etiology ranges from neurological causes such as Parkinson and diabetes to hypovolemia. Drugs, especially cardiovascular drugs are also frequently identified as the cause of OH. The management of OH is primarily nonpharmacological including medication review, dietary, and lifestyle modifications. However, in partially responsive or resistant cases, medications such as fludrocortisone, midodrine, droxidopa, etc., are also used.

Role of an enriched environment in ameliorating early life stress-induced changes in structure and functions of hippocampus and amygdala in rats

Objectives: This study aimed to understand whether an enriched environment (EE) in adulthood benefits in mitigating the early life stress-induced changes in the structure and functions of the hippocampus and amygdala. Materials and Methods: Male Wistar rats were exposed daily for 6 h to early maternal separation and isolation (MS) stress from postnatal days (PND) 4–14 and later at PND 60–70 days subjected to EE, while, the normal control (NC) rats were not subjected to stress but reared with the mother under standard housing conditions. The effects of MS and EE on adulthood behaviour were not subjected to stress but assessed by measuring the ambulatory, repetitive and anxiety-like behaviour. The study has also done the plasma corticosterone concentrations. The dendritic remodelling in the amygdala and hippocampus was assessed using the Golgi cox staining approach. Finally, the present study compared the reactive oxygen species-induced lipid peroxidation and total antioxidant capacity in MS rats as an indirect measure of oxidative stress to study the impact of MS stress on the limbic circuit and peripheral organs. Results: MS rats showed increased anxiety and lower plasma corticosterone levels. The pyramidal neurons’ dendritic plasticity displayed a different pattern, with shrinkage in the CA1 hippocampal neurons and hypertrophy in the amygdala’s primary neurons. Variations in antioxidant activity and peroxidation observed in NC to MS across tissues indicate the occurrence and management of oxidative stress in MS. The 10 days of EE in young adulthood helped to reduce MS stress-induced structural abnormalities in hippocampal and amygdala pyramidal neurons, as well as anxiety and plasma corticosterone levels. Conclusion: These findings together indicate that exposure to adverse experiences may cause harmful effects on brain plasticity and behaviour in young adulthood. Exposure to EE may be beneficial in reducing the early life stress-induced pathophysiology later in life.

Robotic management of congenital urethra-vaginal fistula with transverse vaginal septum

ABSTRACT Introduction: The transverse vaginal septum (TVS) with congenital urethra-vaginal fistula (CUVF) is a rare anomaly of the mullerian duct (1, 2). Incomplete channelling of the vaginal plate, or an abnormality in the fusion of the vaginal component of mullerian duct with the urogenital sinus results in TVS (1, 3, 4). High CUVF occurs due to the persistent communication between the urogenital sinus and utero-vaginal primordium at the tubercle sinus, whereas low CUVF is due to excessive apoptosis of the vaginal plate during channelling (5). The principles of management of CUVF with TVS include: 1) TVS resection, 2) Create a neovagina. We present a case of CUVF with TVS managed by robotic assistance. Material and methods: A 24-year-old female, married for 3 years, presented with cyclical hematuria since menarche, dyspareunia and primary infertility. Examination revealed blind ending vagina 4cm from the introitus. Magnetic resonance imaging revealed a fistulous communication between urethra and vagina, and TVS. Cystourethroscopy confirmed a proximal urethra-vaginal fistula. Urethroscopy guided puncture of the TVS was performed, tract dilated and a catheter was placed across it. Robotic assisted transvaginal approach was planned. Air docking of robot was performed. Traction on the catheter was given to identify the incised edges of the septum. Vaginal flaps were raised laterally, fistulous tract was excised. Proximal vagina mucosa was identified and vaginoplasty was performed. Result: Patient's postoperative recovery was uneventful. Urethral catheter was removed after 5 days. She had normal voiding and menstruation. Vaginoscopy performed at 1st month follow-up, revealed an adequate vaginal lumen. Vaginal moulds were advised for 6 weeks during the night, following which she resumed her sexual activity. She conceived 6 months post-surgery, and delivered a child by caesarean section. Conclusion: We successfully managed this case by resection of septum, neovagina creation and thereby achieving normal menstruation and conception. The advantages of robotic approach were magnification, precision and manoeuvrability in a limited space, avoiding a vaginal release incision.

Use of microalgal biomass as functional ingredient for preparation of cereal based extrudates: impact of processing on amino acid concentrations and colour degradation kinetics

Abstract Suitability of developing Spirulina incorporated cereal based low cost nutritious extrudates was analysed against extrusion processing parameters. Most significant extrusion processing parameters considered for present study were feed moisture (20-25%), die temperature (100-120 °C) and screw speed (50-100 rpm). Different extrusion conditions were used to obtain most acceptable rice: Spirulina blend extrudates. In present study before extrusion processing different additives (citric acid and sodium bicarbonate) were added in rice: Spirulina blend and checked its effect on colour degradation kinetics at varied packaging and storage conditions. Higher screw speed (100 rpm) indicating less residence time of feed material inside the barrel resulted in higher colour retention of rice: Spirulina (97:03) blend extrudates. Kinetics for rice: Spirulina (97:03) blend extrudates indicates faster rate of colour degradation in terms of lightness (half-life of 4 days) when packed in metalized polyethylene at 50°C with 65% relative humidity. Increased concentration of Spirulina (1-3%) in raw formulations resulted in increase in concentration of all amino acids. Impact of extrusion processing has shown non-significant (p ≤ 0.05) effect on amino acid concentrations of rice: Spirulina blend extrudates. Also, all the spirulina added samples showed good consumer acceptability with the score of 6.7

Pancreatic tuberculosis: An unusual presentation

Tuberculosis (TB) of pancreas is a rare presentation in both immune-competent and immune-suppressed patients. Its presenting clinical features are usually vague and non-specific, while radiological features mimic other common pancreatic conditions such as malignancy, so it is often misdiagnosed. It commonly involves the head and the uncinate process of the pancreas. We report a middle-aged immune-compromised man who presented with left-sided tubercular pleural effusion and later was diagnosed as pancreatitis by clinical presentation and TB of pancreas on computed tomography of the abdomen.

Potential Biotechnological Applications of Cyanobacterial Exopolysaccharides

Abstract The cyanobacterial exopolysaccharides (EPSs) are considered as one of the important group of biopolymers having significant ecological, industrial, and biotechnological importance. Cyanobacteria are regarded as a very abundant source of structurally diverse, high molecular weight polysaccharides having variable composition and roles according to the organisms and the environmental conditions in which they are produced. Due to their structural complexity, versatility and valuable biological properties, they are now emerging as high-value compounds. They are possessing exceptional properties and thus are being widely explored for various applications like in food and pharmaceutical industries, in bioremediation for removal of heavy metals, for soil conditioning, as biopolymers, bioadhesives, and bioflocculants. However, poor understanding of their complex structural properties, lack of concrete information regarding the genes encoding the proteins involved in the EPS biosynthetic pathways, their process of production and about the associated factors controlling their structural stability, strongly limits their commercialization and applications in the various fields of biotechnology. Owing to the above context, the present review is aimed to organize the available information on applications of cyanobacterial EPSs in the field of biotechnology and to identify the research gaps for improved industrial utilization and commercialization of these biomaterials.

A comparative profile of bactericidal action of a partially purified bacteriocin from lactic acid bacteria with antibiotics

Aims@#The menace of antibiotic resistance has led to the search for alternatives, which in turn has diverted the attention to bacteriocins, antimicrobial peptides (AMPs) produced by bacteria for their bactericidal properties. The aim of our study was to isolate and partially purify bacteriocin from lactic acid bacteria (LAB) and comparing its antimicrobial activity with antibiotics.@*Methodology and results@#Among 38 LAB screened using agar spot assay, LAB 28D1 showed the highest antimicrobial activity against the test bacterial strains. The proteinaceous nature of the antimicrobial compound extracted from LAB 28D1 was confirmed by its inactivation after treatment with proteolytic enzymes. The crude bacteriocin was found to be stable over a wide range of temperatures (60-100 °C) and pH (4-9). The bacteriocin was partially purified by ammonium sulfate precipitation (ASP) and the activity units were 204,800 AU/mL. The total protein and the specific activity of partially purified bacteriocin were found to be 24.585 mg and 124,954.24 AU/mg respectively. The molecular weight of partially purified bacteriocin was determined to be 8.5 kDa approximately. The efficacy of the partially purified bacteriocin against indicator bacterial strains was compared with antibiotics by the disc diffusion method and minimum inhibitory concentration (MIC). According to our study, the hospital waste isolate Enterococcus spp. was found to be multidrug-resistant (MDR) but sensitive to bacteriocin from LAB (MIC 0.06 ± 0 µg/mL).@*Conclusion, significance and impact of the study@#Bacteriocin from LAB has potential in combating MDR enterococcal infections.

Haemoperitoneum from Spontaneous Rupture of Corpus Luteal Cyst in a Case of Dengue with Thrombocytopenia - A Rare Presentation

Dengue viruses are transmitted to humans by infected mosquitoes, mainly Aedes aegypti and albopictus. Dengue illness is clinically characterized by sudden onset of fever, intense headache, retro orbital pain, myalgia, maculopapular rash, minor bleeding manifestations like petechial rashes, gum bleeding, and severe haemorrhagic manifestations like haematemesis, epistaxis & haemoperitoneum. Haemorrhagic manifestations can occur at any stage. Dengue shock syndrome is a dangerous complication with high mortality.1 Increased vascular permeability together with myocardial dysfunction, dehydration contributes to development of shock resulting in multi-organ failure like liver damage, neurological manifestation & corpus luteal cyst rupture. Endothelial dysfunction induced by cytokines and chemical mediators, results in shock. Corpus luteum is a functional cyst developing in luteal phase of ovarian cycle, which regresses spontaneously to corpus albicans when pregnancy does not occur. Being a thin walled vascular structure corpus luteum is prone to haemorrhage even if bleeding is usually contained inside the cyst. Ruptured functional ovarian cyst is a frequent cause of acute pelvic pain in women of reproductive age. Invariably it is self-limiting with conservative management.2 Occasionally it requires surgical intervention, when accompanied by haemodynamic instability, large haemoperitoneum, especially in disturbed coagulation profile,as in our case.Corpus luteal cyst rupture, with consequent haemoperitoneum is a rare disorder in women of reproductive age. The condition should be promptly diagnosed and treated because delayed diagnosis may significantly reduce women’s fertility and lead to intra-abdominal bleeding, which may be life threatening.3 Ruptured corpus luteal cyst in some instances causes massive intra-peritoneal bleed leading to death, especially with bleeding diathesis.4

Case series on obstetrical outcomes in patient with uterine malformations

Congenital uterine anomalies occur due to abnormal fusion of mullerian duct during embryonic life. It is associated with high incidences of reproductive failures and adverse obstetrical outcomes. It may be associated with malpresentation, preterm labour, or recurrent pregnancy losses. Authors report a case series of 7 patients which were admitted in obstetrics and gynaecology department of SP medical college and associated group of hospitals between time period of March 2019 to July 2019. Among 7 cases 6 cases were associated with malpresentation, 1 with abortion, and 1 with preterm labour. This series shows that uterine anomalies are associated with different obstetrical outcomes varying from totally uneventful antenatal and postnatal period to abortion or preterm labour. Prenatal diagnosis of uterine anomaly may help in improving the obstetrical outcome in these patients.

Gender preference among pregnant women in Nepal

Background:Nepalese society is traditionally patriarchal and son-preferred with increasing numbers of sex-selective abortions. In this context, this study aims to assess the gender preference and associated factors among pregnant women visiting the antenatal care ward of a large public maternity hospital in Kathmandu, Nepal.Methods:A hospital-based cross-sectional study was carried out among 821 antenatal women. Data was collected via face to face interview with structured questionnaire, and gender preference was assessed using Coombs’ scale.Results:At the first instance, more than half 56.2% respondents wished to have two sons and one daughter if they were to have only three children. On asking further questions as per the Coombs’ scale, about 40% of the respondents had son preference falling in IS scale 7-5, 33% had balanced IS-4, and 27% had daughter preference (IS 3-1). The respondent characteristics significantly associated with gender preference were ecological region (p=0.007), education (p=0.009), marital duration (p=0.044) and parity 0.32.Conclusions:The wish to have son is prevalent among the respondents followed by a mixed gender of children. Educational status, ecological region, and parity explain this differential wish. Women’s education and autonomy are the areas to tackle with sex biasof offspring

Pregnancy with pancytopenia: an observational study

Background: Pancytopenia is the reduction in all three major cellular elements of blood; hence it is the simultaneous presence of anaemia, leukopenia and thrombocytopenia. Pancytopenia is associated with many maternal and foetal complications during pregnancy like maternal sepsis, postpartum haemorrhage, pre-eclampsia and preterm labour, IUGR and intrauterine foetal demise.Methods: The study was conducted at BLDE (Deemed to be) University, Shri B. M. Patil Medical College Hospital and Research Centre. It’s an observational study done from November 2019-April 2020. The participants enrolled in the study were subjected for further clinical and laboratory evaluation and followed for feto-maternal outcome.Results: The incidence of pancytopenia with pregnancy in this study was 3% and all the patients were vegetarian by diet along with vitamin B12 and folic acid deficiency. They were associated with different maternal and foetal complications.Conclusions: Proper dietary counselling and well-balanced dietary plans even with plant originate food can prevent the micronutrients deficiency and avoid the deleterious consequences like pancytopenia.

A study of hypertensive disorders of pregnancy and the fetal outcome in a tertiary care hospital: a prospective study

Background: Pregnancy induced hypertension is one of the major causes of feto maternal morbidity and mortality in pregnancy. The exact cause of PIH is unknown certain factors are known to increase the risk of PIH such as risk factor includes that young women with first pregnancy.Methods: The objective of this study was to assess the socio-demographic and clinico-pathological profile of the patients with hypertensive disorders of pregnancy and its associated fetal outcomes. A prospective study was conducted in department of obstetrics and gynecology Shri B. M. Patil Medical College, Hospital and Research Centre, BLDE (Deemed to be University), Vijayapura Karnataka from 15th July to 15th December 2018. All women admitted to labour ward with diagnosis of hypertensive disorders of pregnancy were included in the study after ruling out the exclusion criteria and thorough history, examination and laboratory evaluation were done and followed till delivery.Results: A total of 123 pregnant women with hypertensive disorder of pregnancy were enrolled in the study. Most of the participants were in the age group of 20 to 30 years. The PIH was seen mostly in primigravida, lower socioeconomic status and with lower educational levels. Emergency LSCS is the most common mode of delivery.Conclusions: The hypertensive disorder in pregnancy affects the majorly younger age group. It is most commonly seen in low socio-economic and uneducated population. Hence, there should be provided with proper antenatal care, early detection of hypertensive disorders for better feto-maternal outcome.