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Tuberculosis is one of the major health problems in the developing countries like India. Due to its nonspecific presentation, extra pulmonary TB is diagnosed at later stages.It is an important differential diagnosis for pyrexia of unknown origin (PUO). A 54-year-old male came to hospital with complaints of fever, pain abdomen (on and off), easy fatiguability, reduced appetite, weight loss, breathlessness on exertion for 8 months who completely recovered after starting anti-tubercular therapy.
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Background: Background: Staphylococcus aureus is a gram-negative bacterium that can build strong biofilms on biotic and abiotic surfaces, quickly acquire drug resistance mechanisms, and cause major issues with the treatment of hospital infections. The creation of new therapeutic options has become important due to the limited supply of new antibacterial medications. One of the main sources of bioactive molecules is medicinal plants, and monolaurin is a naturally occurring substance with a variety of biological functions. In light of this, the goal of this study was to assess monolaurin's antibiofilm activity against S. aureus. Methods: Using the AutoDock programme, a docking study of monolaurin against Clf A (clumping factor A) was carried out, and Pymol software was used to evaluate the generated hydrogen bonds in the docked complex. This study demonstrates the positive potential of monolaurin as an antibacterial product and lends support to upcoming pharmacological research on this molecule with an eye toward its therapeutic use. Results: Research was done to support the theoretical absorption of monolaurin in this work and in silico. It was feasible to forecast if the monolaurin molecule may be produced as a medication based on the values of the physical-chemical parameters evaluated using the online tool Swiss ADME. Conclusion: The compound monolaurin demonstrated good receptor ClfA binding affinity with an estimated binding energy of kcal/mol. Natural anti-staphylococcal chemical monolaurin was used as a possible medicine for treating staphylococcal infections in humans by carrying out drug design studies for S. aureus.
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Hypertriglyceridemia(HTG)is the third most common cause of acute pancreatitis but it is relatively rare and requires a highlevel of clinic suspicion. We report a 30 years old male with no co-morbidities who is a non-alcoholic, non-smoker presented with epigastric pain associated with vomiting for two days. His vitals were stable and systemic examination wasunremarkable. Serum lipase levels were elevated [7365 U/l(<40 U/l)]. Computed Tomography of the abdomen suggested acute pancreatitis with extensive peri-pancreatic inflammatory changes with no evidence of pancreatic necrosis. Serum triglycerides were found to be elevated (3450 mg/dl). A diagnosis of HTGinduced acute pancreatitis was made. During evaluation he was found to be diabetic. He was treated with intravenous fluids, IV insulin infusion, and other supportive measures. He was started on statins, fenofibrate and omega3 fatty acids. His condition improved and triglyceride levels after two days were in a declining trend and he was discharged on the same. He was currently under follow up and his serum amylase, serum lipase, serum triglycerides were normal. This case report provides insight into rare cause of acute pancreatitis-HTGwhich if diagnosed at the earliest can be treated promptly.
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Hemoglobinopathies are haematalogical disorders that afflict millions of individuals worldwide. HbE is a hemoglobinvariation caused by a mutation in the ? globin gene that results in the substitution of glutamic acid for lysine at position 26 of the ? globin gene. Hemoglobin (Hb) synthesis abnormalities are among the most prevalent inherited disorders. They can be quantitative (thalassemia syndrome) or qualitative (variant HbS). Hemoglobin E (HbE) is the second most common hemoglobin variation after hemoglobin S (HbS).
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Background: Smoking cessation is the most powerful intervention to modify progression of chronic obstructive pulmonary disease (COPD), and nicotine dependence is one of the most important determinants of success or failure in smoking cessation. Thus, nicotine dependence status and factors associated with moderate to high nicotine Dependence in patients with COPD needs to be evaluated. Method: A hospital based cross-sectional observational study performed on 50 patients with COPD attending the outpatient department at smoking cessation clinic, Institute of Respiratory Diseases, SMS Medical College, Jaipur, Rajasthan during 2019-2020. Result: Multiple logistic regression analysis revealed that low education status, age 60 yrs., and mild to moderate airflow obstruction were related to moderate to high nicotine dependence. Conclusion: Nicotine dependence does not correlate with smoking amount, but with education level, age, and severity of airflow obstruction. Physicians should provide different strategies of smoking cessation intervention for current smokers with COPD according to their education levels, age, and severity of airflow obstruction.
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The most widely prescribed drugs for the treatment of a variety of dermatoses are Topical corticosteroids (TC). These medications are approved for the treatment of inflammatory and pruritic manifestations of dermatologic disorders due to their powerful symptom-relieving impact. Clobetasol propionate (CP) is the most popular (TC) used to relieve itching, redness, and oedema caused by a variety of skin disorders. Anti-inflammatory, anti-pruritic, and vasoconstrictive characteristics are all present in it. CP works by binding to cytoplasmic glucocorticoid receptors and activating glucocorticoid receptor-mediated gene expression, resulting in the production of anti-inflammatory proteins while suppressing the production of inflammatory mediators. The formulation is free from known contact allergens, such as propylene glycol, short-chain alcohols, and sorbitol-based emulsifiers, and has demonstrated hypoallergenic effects. The efficacy, safety, and clinical experience of utilizing CP 0.025% cream for the treatment of various dermatologic disorders are discussed in this case series
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India is one of the world抯 worst affected countries due to COVID-19 pandemic. The world is struglling to fight agaisnt centuries pandmemic. Globally goverments have been imposed lockdown and restrictions to control situation and minimise spread of infection. Social media was found the most practical and efficiant mediam to share information and opnions about pandmemic. At time of social distancing, social media helped people to share their feelings and find support. Same time overuse of social media palteform created panic and misinformation across countries. People sharing unconfirmed information about covid pandmemic and goverments were found it difficult to handle
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Kisspeptin or GPR-54 is a product of KISS 1 gene regulating the production of gonadotropin releasing hormone (GnRH), luteinizing (LH) as well follicle stimulating hormone (FSH). Both LH and FSH are important hormones for reproduction in animals as well in humans. The recognition of Kisspeptin has a landmark bearing in reproductive biology. Few recent pilot studies have convincingly proven it to be a promising molecule in treating infertile couples especially those having hypogonadotropic hypogonadism not responding to conventional treatment
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Introduction: Resurfacing soft tissue defects of the posteriordistal leg is a magnanimous surgical task. Numerous surgicaloptions exist but they are aesthetically displeasing. Thishas propelled us to explore the ideal flap and microscopicexamination of deep fascia helped in the evolution of non-axialfascial hinged flap as almost ideal cover. This flap is based ona suprafascial and subfascial plexus. With this objective thestudy was undertaken and surgical experience, planning andsafe dimensions of such flaps were described and discussed.Material and Methods: Thorough flap planning for softtissue defects on the distal leg, dimensions of the defect,preoperative assessment of the donor tissue and surgicalexecution were carried out. Different parts of the flap,dissected and undissected, were mathematically calculatedbased on the anatomical and vascular knowledge and surgicalexperience.Results: The mean age of the 42 patients was 35.02 years(range 18-56 years). Majority were males in the age groupof 21-40 years. The mean size of the flaps was 25.55 cm2,largest flap 10 cm and 6 cm wide. The average hospital staywas 21.09 days and follow up of 4-18 months. Complicationswere occasional and responded to conservative managementand patient counselling.Conclusion: The distally based non-axial fascial hingedflaps is extremely useful for small to moderate size defects ofposterior distal leg defects and gives gratifying results. Thefact that it is thin, stable, durable along with reconstructiondone in one stage adds to the value of the flap
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Incidence of breast malignancy is increasing in India which can be attributed mostly to changing lifestyle and increased hormone usage, and partly to increasing awareness. We wanted to determine the prevalence of malignant breast lesions in females, evaluate the histological spectrum of malignant breast lesions and study their association with common findings like age, side, histological grade and their biological behaviour.METHODSPresent study is a two-year (August 2016 to July 2018) cross sectional study of malignant lesions of female breast, conducted in the Department of Pathology of Jawaharlal Lal Nehru Medical College, Ajmer, Rajasthan.RESULTSIn this study, 159 malignant lesions of the female breast were diagnosed during study period that comprised of 26.02% of total breast lesions and 1.22 % of the total histopathological samples received. Age of the females having malignant breast lesions ranged from 28 years to 92 years with a mean age of 52.87 ± 12.944 years. The incidence of malignant breast lesions was maximum in 5th and 4th decades of life. The most common clinical symptom for presentation was the palpable lump (79.25%) in the breast. Lesions were more common in the right breast (53.5%), than left. The commonest quadrant involved in malignant lesions of breast was upper outer (30.19%). Infiltrating ductal cell carcinoma was the most common malignant lesion (85.33%) followed by invasive lobular carcinoma (5.66%). Out of 99 specimens having lymph node with it, 65 (65.66%) cases show metastatic deposits of malignancy. Grade II (MBR score) lesions (51.35%) were found most commonly.CONCLUSIONSHistopathology of the malignant lesion is useful in understanding the morphological and biological behaviour of the malignancy as some types of malignancy have aggressive behaviour. Grading and staging have an important role in treatment plan (surgery, radiotherapy, chemotherapy and hormonal therapy) and also in assessing the prognosis
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Background: Abdominal tuberculosis is found worldwide although prevalence rates are still highest in the developing countries. The sites of involvement of abdominal tuberculosis are peritoneum, lymph nodes, intestine and solid viscera. The objectives of this study were to describe the clinical profile of patients with abdominal tuberculosis, to review the use of diagnostic modalities, both non-invasive and invasive and to study the outcome of management of abdominal tuberculosis.Methods: This is an observational retrospective study of 30 patients with diagnosis of abdominal tuberculosis treated at university linked teaching hospital of South Gujarat from August 2015 to November 2017.Results: In our study, disease was found almost equally prevalent in both rural and urban areas affecting mostly lower socio-economical class. The mean age was 34 years (range from 13 to 62); male and female ratio was 2.33:1; the mean hospital stay was 09 days (range from 5 to 48 days). Abdominal pain was present in almost all cases, having chronic pain in 21 patients and acute in 9 patients. There were 05 (16.7%) patients found to be HIV positive in this study. There was mortality of 02 patients post operatively due to sepsis in those patients operated in emergency with peritonitis.Conclusions: Abdominal tuberculosis is prevalent in lower socioeconomic class patients and affects younger male patients more commonly. Most commonly intestinal and mesenteric disease presented with chronic abdominal pain and constitutional symptoms of tuberculosis.
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Background: NH affects nearly 60% of term and 80% of preterm neonates during first week of life. 6.1% of well term newborn have a serum bilirubin over 12.9 mg%. Serum bilirubin over 15 mg% is found in 3% of normal term newborns. Neonatal Hyperbilirubinemia (NH) is a cause of concern for the parents as well as for the paediatricians. Aim of study to find out the association between various levels of cord serum albumin (CSA) and significant neonatal hyperbilirubinemia requiring interventions like phototherapy or exchange transfusion and whether it can be used as a risk indicator for subsequent development of significant jaundice.Methods: The present study was conducted on 150 randomly selected eligible term neonates delivered at Department of Pediatrics, Rajkiya Mahila Chikitsalaya, JLN Medical College and Associated Group of Hospitals, Ajmer, India.Results: Authors conducted a prospective study on 150sequentially born term babies. Cord blood was collected at birth and cord serum albumin estimation was done within 4-6 hours of collection of the blood. Cohort was grouped into Group 1, Group 2 and Group 3 based on CSA level ≤ 2.8g/dl, 2.9-3.3g/dl and ≥ 3.4 g/dl respectively. Knowledge of risk factors of NH in neonates could influence decision of early discharge vs. prolonged observation cord serum albumin level of ≤ 2.8g/dl has a correlation with incidence of significant hyperbilirubinemia in term newborns. So this ≤ 2.8g/dl of cord serum albumin level can be used as risk indicator to predict the development of significant hyperbilirubinemia. Whereas cord serum albumin level ≥3.4g/dl is considered safe.Conclusions: Term neonates with hyperbilirubinemia with a total serum bilirubin level ≥17 mg/dl had levels of cord serum albumin of ≤ 2.8 g/dl, and this can be used as a risk indicator to predict the development of NH.
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Background: Promotion of drugs has been increased enormously with the advancement of technology and use of internet and media etc. Pharmaceutical manufacturers spend vast amount of money on promotion usually through medical representatives by providing printed advertisements. But, it has been seen that these printed advertisements are not up to the mark usually, they either overemphasize the efficacy or hide the safety profile for the sake of company抯 profit. All these promotional activities influence the prescribing pattern of doctors. So, the present study has been conducted to assess the knowledge and attitude of second year undergraduate students about promotional literature and to train them accordingly for improving the prescribing behaviour.Methods: A questionnaire based study containing 9 questions was conducted in 110 second year undergraduate students after taking informed consent. Statistical analysis was done by using descriptive statistics by graph pad prism version 6.01.Results: Among respondents 60 (61.2%) were males and rest 38 (38.8%) were females. 50 (51%) of the respondents have chosen Indian pharmacopoeia as a trusted source of information followed by others. Most common factor affecting the prescribing attitude was reported as updates from clinical trials 49 (50%) followed by prescriber抯 knowledge. Most important intervention taken to stop misleading drug promotional activities has been reported as formulation of strict regulation by the health care authorities against any misleading promotion.Conclusions: Promotional activities by manufacturers influence the attitude and prescribing pattern of doctors. So, it is important to teach the students about their rational use by critically analysing it.
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Background: Tuberculosis is one of the top 10 cause of death globally. Extra-pulmonary tuberculosis is an important clinical problem. Extra-pulmonary tuberculosis range from 30%-53% in India. Diagnosis of extra-pulmonary tuberculosis is still challenging despite many investigations. World Health Organization recommends Gene-Xpert Mycobacterium Tuberculosis/Rifampicin (Cartridge Based Nucleic Acid Amplification Test-CBNAAT) over conventional tests for diagnosis of extra-pulmonary tuberculosis which permits rapid tuberculosis diagnosis through detection of the genetic sequence of DNA of mycobacterium tuberculosis and simultaneous identification of a majority of the mutations that confirm Rifampicin resistance which is highly predictive of multi-drug resistant tuberculosis.Methods: Study was carried out over a period of one year. Patients with suggestive of extra-pulmonary tuberculosis were included in study. Diagnosis of extra-pulmonary tuberculosis carried out by clinical, radiological, biochemical analysis, cytological, bacteriological confirmation. Based on mycobacterium tuberculosis result, the study population were divided into ‘Mycobacterium Tuberculosis detected’ and ‘Mycobacterium Tuberculosis not detected’ groups. Mycobacterium Tuberculosis detected group was further divided into ‘Rifampicin resistant’ and ‘Rifampicin sensitive’.Results: Total 220 patients were included. Among extra-pulmonary tuberculosis, there were 83.64% were pleural fluid. 65.91% patients where be <45 years of age. Mostly patients were from rural areas and illiterate. Diabetes Mellitus found as the most common co-morbidities. CB-NAAT was able to detect mycobacterium tuberculosis in 35% (77) extra-pulmonary samples, out of which 6 were rifampicin resistant. Out of 184 samples of pleural fluid, 53 were rifampicin sensitive and 4 were found rifampicin resistant.Conclusions: CB-NAAT has to be endorsed in every health care centres as the test gives rapid result and also detection of rifampicin resistance which is the major concern for every clinician.
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Introduction: TB is one of the top 10 causes of death globally. PTB is most common presentation. Lymph node TB is the most common type of EPTB constitutes about 35% cases followed by pleural effusion(20%), bone and joint(10%), genitourinary TB(9%), TB Meningitis(5%), abdominal tuberculosis(3%), other(10%). WHO also recommends Gene Xpert MTB/RIF over conventional tests which permits rapid TB diagnosis through detection of the genetic sequence of DNAof mycobacterium TB and simultaneous identification of a majority of the mutations that confirm Rifampicin resistance which is highly predictive of MDR-TB. Methodology: Study was carried out over a period of one year in a tertiary care centre. Patients with suggestive of pleural effusion were included in study. Pleural fluid was drawn using standard protocol and sent for CBNAAT test and bacteriological examination. Based on MTB result, the study population were divided into 'MTB detected' and 'MTB not detected' groups. MTB detected group was further divided into 'Rif' Resistant and 'Rif' sensitive group. All the collected information was filled in predesigned proforma in excel sheet for final analysis. Chi squire test or suitable formula was applied to know the significance of our study. Results: 203 patients were included with a male to female ratio of 2.98:1. 65.91% patients were below 45 years of age. Mostly patients were from rural areas and illiterate. 38.64% had different type of substance abuse habit. DM (29.03%) found as the most common co-morbidities. CBNAAT test was able to detect MTB in 76 (37.44%) extra-pulmonary samples, 70 were Rifampicin sensitive and 6 were 'Rifampicin' resistant.
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Background: With the changing lifestyle, the incidence of psychiatric illness is increasing day by day. And the mental illnesses not only affect the social and personal life but also adds additional economic burden affecting quality of life of the person. So, proper diagnosis and management of psychiatric illnesses is utmost important. So, keeping this in mind, the present study has been conducted to evaluate drug utilization pattern of psychotropic medicines in tertiary care centre of Bastar region.Methods: After obtaining approval from Institutional Ethics Committee, present study was conducted in 237 patients for a period of 3 months from February 2019 to April 2019. The data of patients attending psychiatry OPD was collected in a structured case record form. The data were analysed using graph pad prism version 6.0.Results: Out of total 237 patients, males 136(57.38%) outnumbered females 101 (42.62%). The major psychiatric illness reported was schizophrenia (45.99%) followed by bipolar affective disorder (16%) and generalized anxiety disorder (14.35%). Average number of psychotropic drugs per prescription was 1.74±1.02. The percentage of drugs prescribed from state Essential drug List (EDL) was 93.05%.Conclusions: Overall, the principles of rational prescribing was tried to be maintained, as polypharmacy has been avoided and most of the drugs were prescribed from the state EDL. The use of generic drugs should be increased to make prescriptions more rational and to cut down the cost of the therapy which may be helpful in increasing the quality of life of the patients.
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The aim of the study is to evaluate instead serum C – reactive protein level and Erythrocyte sedimentation rate as a monitoring tool for all patients to determine severity of infection, attending the OPD in a tertiary care hospital. Methods: This study was conducted in Department of Microbiology & Pathology in Heritage Institute of Medical Sciences, Varanasi. Serum CRP level was measured by CRP analyzer & ESR by Wintrobe’s method. Results: In above study, A total numbers of 240 cases were included, out of which 43.4% were male and 56.7% were females. Among the total number of patients, 76.7% were CRP positive & rest were CRP negative. While, in case of ESR it was elevated in 63.4% cases & rest were normal before starting the treatment. Conclusion: This study conclude that both CRP and ESR aid in analysis and monitoring of the disease but assessment of serum CRP level is much more sensitive in infections.
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Retrocaval ureter also referred to as pre-ureteral vena cava or circumcaval ureter is a rare congenital anomaly with the ureterpassing posterior to the inferior vena cava. Although it is a congenital anomaly, patients do not normally present with symptomsuntil the 3rd and 4th decades of life after a resulting hydronephrosis. We present the report of a 12-year-old male child with ahistory of right flank pain and associated right proximal hydroureteronephrosis. Diagnosis was confirmed with computerizedtomography urography, and an open surgical repair was done for the anomaly. The case is discussed here along with reviewof recent literature.
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Background: Rabies is one of the deadliest diseases of mankind, and has terrified since antiquity. It is 100 per cent fatal, however, 100% preventable. In India, rabies causes an estimated 20,565 deaths with 17.4 million exposures to animal bites, mainly dog bites, occurring every year. In India a person is bitten by an animal in every 2 seconds and someone dies from rabies every 30 second. Complete post-exposure prophylaxis is necessary among the animal bite cases for complete protection. Hence this study aims to determine the patient’s compliance for intradermal anti-rabies vaccination and also to determine the constraints for compliance.Methods: A retrospective record based study was conducted in the ARC of S.M.S.M.C, Jaipur where patients were provided intradermal rabies vaccination (updated Thai Red Cross regimen) for post-exposure prophylaxis. The records maintained at ARC-SMSMC under department of community medicine from March 2016- February 2017 were analysed. The total number of patients was 8873 from which 8590 subjects were recruited for the study after excluding category I cases, pre-exposure cases rat bite, human bite, re-exposure and pre-exposure cases. The major constraints were found out by interviewing the patient/guardian through the telephone.Results: The compliance rate for intradermal rabies vaccination (IDRV) is 81.87%. The major constraints were timings not convenient, personal or social workload, long distance from the hospital, forgotten the dates.Conclusions: The compliance rate for rabies vaccination is considerably low for this highly fatal disease. Considering these major constraint factors, the animal bite victims should be motivated effectively through health education at the time of initiation of vaccination course to attain the goal of rabies free India.
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Background: Self medication is becoming very popular among medical students as they get exposed to knowledge about diseases and drugs, but which is very superficial in second year undergraduates, so the present study was conducted to evaluate the knowledge, attitude and practice (KAP) of self medication among second year undergraduate students.Methods: A questionnaire based study containing 12 questions was conducted in 175 second year undergraduate students after taking informed consent. Statistical analysis was done by using descriptive statistics by Graph Pad Prism version 6.01.Results: Out of the 175 students, 155 (88.57%) students have taken self medication. The common reason for taking it was no need to visit the doctor for minor illness (64%), quick relief (48.57%) and time saving (34.29%). The common indications for taking self medication were fever (69.14%) and cough and cold (69.14%) followed by headache (64%). Although students rarely practised it due to risk associated like adverse effects 131 (74.86%) and lack of proper knowledge about drugs 118 (67.3%).Conclusions: Self medication is highly prevalent among students, as most of the students get it from pharmacies, it is necessary to make strict guidelines for availability of such medicines over the counter and also there is need to educate the students about harmful consequences of self medication to make them responsible future doctors.