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Background: Low cardiac output is a common complication following cardiac surgery and it is associated with higher mortality in the pediatric population. A gold standard method for cardiac output (CO) monitoring in the pediatric population is lacking. The present study was conducted to validate cardiac output and cardiac index measured by transthoracic echocardiography and Pressure recording analytical method, a continuous pulse contour method, MostCare Up in postoperative pediatric cardiac surgical patients. Materials and Methods: This was a prospective observational clinical study conducted at a tertiary care hospital. A total of 23 pediatric patients weighed between 2 and 20 kg who had undergone elective cardiac surgery were included in the study. Results: Spearman抯 correlation coefficient of CO between transthoracic echocardiography (TTE) and Pressure Recording Analytical Method (PRAM) showed of positive correlation (r = 0.69, 95% Confidence interval 0.59?0.77, P < 0.0001) Linear regression equations for CO between TTE and PRAM were y = 0.55 + 0.88x (R2 = 0.46, P < 0.0001). (y = PRAM, x = TTE), respectively. Bland? Altman plot for CO between TTE and PRAM showed a bias of ?0.397 with limits of the agreement being ?2.01 to 1.22. Polar plot analysis showed an angular bias of 6.55� with radial limits of the agreement being ?21.46 to 34.58 for CO and angular bias of 6.22� with radial limits of the agreement being ?22.4 to 34.84 for CI. Conclusion: PRAM has shown good trending ability for cardiac output. However, values measured by PRAM are not interchangeable with the values measured by transthoracic echocardiography.
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ABSTRACT Splenogonadal fusion is an infrequent cause of testicular or scrotal swelling with less than 250 cases reported. We report the case of a 27-year-old male who presented with painless scrotal swelling. The sonography showed a homogeneous, well-encapsulated left extratesticular mass, which was surgically removed. The gross examination revealed a grey-brown tissue below the left testis. The microscopy of the grey-brown mass revealed splenic tissue, and the testis showed maturation arrest, resulting in the diagnosis of splenogonadal fusion. These can be easily mistaken for a tumor, especially in this age group. Reporting such an entity increases awareness among clinicians, radiologists and pathologists, which will aid in preventing an orchiectomy for these patients.
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Background: Influenza activity was reported to be below the seasonal levels during the Coronavirus disease?2019 (COVID?19) pandemic globally. However, during the severe acute respiratory syndrome corona virus?2 outbreak, the routine real?time surveillance of influenza?like illness and acute respiratory infection was adversely affected due to the changes in priorities, economic constraints, repurposing of hospitals for COVID care, and closure of outpatient services. Methods: A systematic review and meta-analysis were carried out to assess the pooled proportion of symptomatic cases tested for influenza virus before the current pandemic in 2019 and during the pandemic in 2020/21. An electronic search of PubMed/MEDLINE, Scopus, and Google Scholar was carried out for the articles reporting the impact of the COVID?19 pandemic on influenza surveillance among humans using search terms. The study was designed based on Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and the meta-analysis was performed to synthesize the pooled proportion of patients sampled for influenza with 95% confidence interval (CI). Results: The nine qualified studies from the WHO European region, Canada, Japan, Germany, Italy, Spain, South Africa, and the United States were pooled by random?effects meta?analysis. The overall pooled proportion of symptomatic cases sampled for influenza surveillance before and during the pandemic was 2.38% (95% CI 2.08%–2.67%) and 4.18% (95% CI 3.8%–4.52%), respectively. However, the pooled proportion of samples tested for influenza before the pandemic was 0.69% (95% CI 0.45%–0.92%) and during the pandemic was 0.48% (95% CI 0.28%–0.68%) when studies from Canada were excluded. Conclusion: The meta-analysis concludes that globally there was a decline in influenza surveillance during the COVID?19 pandemic except in Canada.
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The ascomycete fungal pathogen Ustilaginoidea virens (Cooke) Takahshi cause false smut in rice and considerable yield loss. In this study, we collected isolates of U. virens from the rice growing ecosystems of Karnataka and characterized for cultural, morphological and molecular characters. The isolates of the fungus on Potato Sucrose Agar media exhibited distinct colonies with colony growth ranging from 21.50 mm (Uv-20) to 70.00 mm (Uv-15). The colony colour appeared as whitish to yellowish with varied growth pattern from flat, raised flat to fluffy and raised fluffy colonies with sectoring in Uv-1, Uv-3, Uv-6 and Uv-9 isolates. The isolates of U. virens also showed variation in the morphology of spores, where the conidia were globose, irregularly round to elliptical and warty on the surface with spore radius ranging from 2.91 to 5.36 ?m. The scanning electron microscopy revealed hyaline globose to irregularly rounded ornamented chlamydospores with prominent spines. Besides cultural and morphological characters, molecular identification of false smut isolates was confirmed through ITS sequencing which showed 91 to 99 per cent identity with U. virens in NCBI-BLAST analysis. Dendrogram constructed using ITS sequence data broadly separated the isolates into two major clusters with divergence among clusters. This ITS (internal transcribed spacer) sequencing of isolates should help better understanding of the phylogenetic relationships among these isolates.
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Context: The globalization in the process most of the rural sectors are also upgrading technically with digitalization with more availability of smart phones and gaming along with the refined food influences on the present?day children is causing a trend of overweight among the children. Aims: To arrive at the prevalence of overweight and obesity considering the Indian Academy of Pediatrics (IAP) cut?offs for growth standards among children aged 12 years from the rural and urban areas of Mysuru District. Methods and Material: The present program was the third large scale community intervention project carried out including the 7 talukas of Mysuru District which focused on the measurement of the Body mass index (BMI). In this phase between the year 2019 and 2020 anthropometric measurements were undertaken in 1602 urban and rural children aged 12 years from government?funded and privately?funded schools of Mysuru District. Statistical Analysis Used: The results were analysed statistically using SPSS for Windows (version 23.0) and the t?test, Chi?square test and proportion tests, P value were reported. Results: As per the IAP reference ranges the prevalence of obesity was 5.5% and overweight was 7.1% among children of Mysuru District. Conclusions: We report that this increase was significantly higher in girls than boys. There was an increasing trend in rural sectors; however, the obese children were more predominantly distributed among the urban sectors. This calls for a precise preventive measure to fulfil the goal of the World Health Organization (WHO) to control prevalence of childhood obesity by the year 2022
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Aim:To determine the factors associated with an inadequate response to adenosine infusion during cardiac stress magnetic resonance imaging (MRI). Study Design: It is a retrospective cohort study. Introduction: Stress cardiac MRI is a highly accurate and non?invasive method to diagnose coronary artery disease (CAD). Stress MRI is performed by inducing stress with adenosine infusion.There is an increase in systemic andmyocardial blood flow (MBF) with vasodilator agents. Capillaries are maximally dilated in a diseased artery and cannot sustain increased myocardial oxygen demand. It results in delayed delivery of contrast, which leads to an area of perfusion defect in the myocardium. These perfusion defects can be accurately seen by cardiovascular magnetic resonance (CMR) and help in the prognosis of patients. Methods: A retrospective study on patients subjected to cardiac stress MRI was conducted in a Tertiary Care Cardiac Center from January 2019 to January 2022. In total, 99 patients underwent adenosine stress perfusion cardiac MRI. All patients received an adenosine infusion of 140 mcg/kg/min for 2 min. Subsequently, the dosage was increased by 20 mcg/kg/min every 2 min to a maximum of 210 mcg/kg/min until an adequate stress response was achieved. Adequate stress was defined as two or more of the following criteria: 1) Increase in heart rate >/= 10 beats perminute. 2) Decrease in systolic blood pressure SBP by >/= 10mmHg Symptoms like chest discomfort, breathlessness, and headache. Patients who satisfied two or more of the above criteria were labeled as responders and the patients who did not satisfy the above criteria with the maximum dose of 210 mcg/kg/min of adenosine infusion were labeled as non?responders. Multivariable logistic regression analysis with forward and backward stepwise selection was used to identify predictors in non?responders. Basic demographic variables with P value </= 0.2 were examined for inclusion in the model. A P value </= 0.05 was considered significant. Results: Nine patients (9.1%) showed inadequate stress response to adenosine infusion even with a maximum dose of 210 mcg/kg/min. Multivariate logistic regression analysis showed that left ventricular end?diastolic volume (LVEDV) was a predictor of inadequate response to adenosine infusion. Conclusion: Inadequate stress response to adenosine occurred in 9.1% of subjects with an infusion of 140–210 ug/kg/min. LVEDV is an independent and strong predictor in non?responders.
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A good armamentarium facilitates the efficient working of the dentist which in turn improves the quality of treatment rendered to the patient. The present invention of the unit consisting of the flexible mirror attached to the suction and the dual suction tip aims at improving the clinical efficiency of dental treatments provided. This compact unit is designed to improve the visualization and isolation of the operating field. It is also easy to fabricate and alleviates the very relevant shortcomings of clinical work.
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A 28?year?old female who underwent an uneventful femtosecond laser enabled keratoplasty (FLEK) in her left eye presented with pain, redness, and blurring of vision in the operated eye two weeks after getting immunized with COVID?19 vector vaccine (ChAdOx1 nCoV19 Vaccine Recombinant COVISHIELD, AstraZeneca). Slit?lamp examination showed donor stromal edema with Descemet’s membrane folds and Khodadoust line (KP’s on endothelium) with anterior chamber cells and flare. The patient was diagnosed with acute corneal graft rejection and advised hourly topical steroids with cycloplegics and oral steroids. The patient responded to treatment and there was progressive reversal of graft rejection with the patient achieving best spectacle?corrected visual acuity (BSCVA) of 20/30 after five weeks of treatment. Our case highlights possible immune corneal graft rejection after COVID19 vaccination and the need to step up topical steroids before vaccination
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Scrub typhus, also called bush typhus, is a zoonotic disease a Gram-negative bacterium. Its presentation may range from nonspecific febrile illness to severe disease, with cardiovascular, renal, hepatic and neurological involvement. Myocarditis is one of the rare complications of scrub typhus. Hence, we are reporting a case of a 50-year-old male, farmer by occupation, presenting to us in multiorgan dysfunction syndrome who developed myocarditis during second week of his illness.
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Objective:Thoracic Epidural Analgesia (TEA) was compared with ultrasound?guided bilateral erector spinae plane (ESP) block in aorto?femoral arterial bypass surgery for analgesic efficacy, hemodynamic effects, and pulmonary rehabilitation. Design: Prospective randomized. Setting: Tertiary care centre. Participants: Adult patients, who were scheduled for elective aorto?femoral arterial bypass surgery. Interventions: It was a prospective pilot study enrolling 20 adult patients who were randomized to group A (ESP block = 10) and group B (TEA = 10). Monitoring of heart rate (HR) and mean arterial pressure (MAP) and pain assessment at rest and deep breathing using visual analog scale (VAS) were done till 48?h post?extubation. Rescue analgesic requirement, Incentive spirometry, oxygenation, duration of ventilation and stay in Intensive Care Unit (ICU) were reported as outcome measures. Statistical analysis was performed using unpaired Student T?test or Mann?Whitney U test. A value of P < 0.05 was considered significant. Results: HR was lower in group B than group A at 1 and 2 h post? surgery and at 0.5, 16, 20, and 32 h post?extubation (P < 0.05). MAP were lower in group B than A at 60, 90, 120, 150, 180, 210, 240, 270 minutes and at 0 hour post?surgery and at 4 hours, every 4 hours till 32 hours post?extubation (P < 0.05). Intraoperative midazolam and fentanyl consumption, ventilatory hours, VAS at rest, incentive spirometry, oxygenation, and ICU stay were comparable between the two groups. VAS during deep breathing was more in group A than B at 0.5, 4 hours and every 4 hours till 44 hours post?extubation. The time to receive the first rescue analgesia was shorter in group A than B (P < 0.05). Conclusion: Both ESP block and TEA provided comparable analgesia at rest. Further studies with larger sample size are required to evaluate whether ESP block could be an alternative to TEA in aorto?femoral arterial bypass surgery
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To determine the effect of inspiratory muscle training (IMT) on pulmonary function, respiratory muscle strength (RMS), and functional capacity in patients undergoing cardiac surgery. The PubMed, PEDro, CINAHL, Web of Science, CENTRAL, and EMBASE databases were searched from inception to June 2020. Randomized controlled trials (RCTs) that evaluated patients who underwent cardiac surgery were included in this review. Meta-analysis performed using a random-effects model showed that the mean difference in forced vital capacity, forced expiratory volume in 1 second, 6-minute walk distance, and RMS was 3.47% (95% confidence interval [CI], 0.57 to 6.36), 5.80% (95% CI, 2.03 to 9.56), 78.05 m (95% CI, 60.92 to 95.18), and 4.8 cmH2O (95% CI, -4.00 to 13.4), respectively. There is strong evidence that IMT improves inspiratory muscle strength, pulmonary function, and functional capacity, and reduces the length of hospital stay in patients undergoing cardiac surgery.
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To determine the effect of inspiratory muscle training (IMT) on pulmonary function, respiratory muscle strength (RMS), and functional capacity in patients undergoing cardiac surgery. The PubMed, PEDro, CINAHL, Web of Science, CENTRAL, and EMBASE databases were searched from inception to June 2020. Randomized controlled trials (RCTs) that evaluated patients who underwent cardiac surgery were included in this review. Meta-analysis performed using a random-effects model showed that the mean difference in forced vital capacity, forced expiratory volume in 1 second, 6-minute walk distance, and RMS was 3.47% (95% confidence interval [CI], 0.57 to 6.36), 5.80% (95% CI, 2.03 to 9.56), 78.05 m (95% CI, 60.92 to 95.18), and 4.8 cmH2O (95% CI, -4.00 to 13.4), respectively. There is strong evidence that IMT improves inspiratory muscle strength, pulmonary function, and functional capacity, and reduces the length of hospital stay in patients undergoing cardiac surgery.
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Renal cell carcinoma (RCC) is a malignant disease that is often diagnosed at a metastatic stage. The head and neck represent up to 3% of the metastatic RCC, and the paranasal sinus area is one of the least involved sites. Here, we introduce the case of a 74-year-old female patient who presented with a history of traumatic nasal bleed. A cranial computed tomography scan and magnetic resonance imaging showed a fronto-ethmoidal mass with pachymeningeal involvement. A nasal biopsy from the paranasal sinuses was taken. On histopathological examination, metastatic clear cell carcinoma was the main hypothesis, which later was confirmed to be RCC on immunohistochemistry. On further radiological examination, an exophytic mass was depicted in the kidney's upper and middle pole. The patient had no renal complaints and was asymptomatic. Fronto-ethmoidal sinus is a rare site for metastatic RCC, especially in cases where the patient is asymptomatic. Early detection by keeping RCC metastasis as the differential diagnosis in such cases can lead to early treatment and improve the overall survival of the patient.
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Humans , Female , Aged , Paranasal Sinuses , Carcinoma, Renal Cell/complications , Kidney Neoplasms/pathology , Epistaxis/pathology , Diagnosis, DifferentialABSTRACT
The search for novel antibiotics is of immense importance in research areas around the world for agricultural,pharmaceutical, and industrial applications. The Streptomyces species are widely used as an importantbiological tool for the production of a wide range of novel secondary metabolites. In the present study, isolatedstrain RSA-14 from rhizosphere soil of Alternanthera sessilis was subjected to morphological, physiological,biochemical and 16S rRNA gene sequence analysis. The isolated RSA-14 was analyzed for antimicrobialactivities by cross streak method and exhibited a broad spectrum of antimicrobial activity against test pathogens.The isolate was tested for the ability to grow in the presence of antibiotics, such as penicillin, streptomycin,chloramphenicol, gentamycin, and tetracycline and resistant to only two antibiotics, and sensitive to others. The16S ribosomal RNA gene sequencing and analysis of the phylogenetic tree showed 100% sequence similaritywith Streptomyces cinereoruber strain P.B.373.
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Objective: The present goals of our study were biological synthesis, characterizations of silver nanoparticles, and evaluation of its antimicrobial activity against microbial pathogens like Escherichia coli, Enterococcus faecalis, Streptococcus pneumoniae and Staphylococcus aureus. Methods: The bacterial Strain NS-24 was isolated on nutrient agar medium and was selected for the synthesis of silver nanoparticles based on its gram-negative characteristics. The characterizations of silver nanoparticles were done by UV-Visible spectroscopy, Atomic Force Microscopy (AFM), High Resolution-Transmission Electron Microscopy (HR-TEM), Scanning Electron Microscopy (SEM) with Energy Dispersive Spectroscopy (EDX), X-ray Diffraction (XRD) and Fourier Transform Infrared Spectroscopy (FTIR). Later, the molecular characterization of the Strain NS-24 was done by DNA extraction and 16S rRNA gene sequencing. Results: The UV-visible spectrophotometric observation of the Strain NS-24 supernatant and AgNO3 solution showed maximum absorbance at 423 nm. The AFM data confirmed that the particles were polydispersed and spherical in shape. Additionally, the FTIR analysis revealed the IR spectral band patterning and TEM analyzes showed the size of biological AgNPs was in the range of 12.56 nm to 27.32 nm, with an average of 18.06 nm in size. Further, the 16S rRNA gene sequencing revealed the identity of Strain NS-24 as Stenotrophomonas maltophilia. The antimicrobial activity of AgNPs was studied on different gram-negative and gram-positive bacterial strains like Escherichia coli (MTCC 40), Enterococcus faecalis (MTCC 6845), Streptococcus pneumoniae (MTCC 8874) and Staphylococcus aureus (MTCC 2825), which showed good inhibition of their growth at varying concentrations of AgNPs against all the pathogens. Conclusion: Our findings showed that the synthesized AgNPs from the isolated bacterium was small in size and had profound antibacterial activity against pathogenic micro-organisms.
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Peripheral Ameloblastoma (PA) is a benign odontogenic tumor, arising from the cell rest of Serres, reduced enamel epithelium and basal cells of the surface epithelium. Peripheral ameloblastoma is a rare odontogenic neoplasm occurring commonly in the mandibular gingiva. PA clinically resembles other peripherally occurring lesions like pyogenic granuloma, peripheral ossifying fibroma, peripheral giant cell granuloma, and squamous papilloma. The recurrence rate of PA is 16-19% which demands a straight follow up. We report a case of recurrent peripheral ameloblastoma occurring in a 72-year old male located in the mandibular lingual gingiva in relation to the 44, 45 element's regions. The patient had a primary lesion excised from the same site 6 years before which was diagnosed as ameloblastoma.
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Humans , Female , Aged , Ameloblastoma/diagnosis , Jaw Neoplasms , Odontogenic Tumors , Neoplasm Recurrence, LocalABSTRACT
Background: Ending the tuberculosis (TB) epidemic by 2030 is among the health targets of the sustainable development goals. Side effects to anti-TB drugs are common and may lead to reduced compliance to treatment. These adverse effects must be recognized early to reduce associated morbidity and mortality. Objective of this study was to determine the adverse drug reactions (ADR) to anti-tubercular therapy among patients visiting directly observed treatment, short-course (DOTS) centre MIMS, Mandya.Methods: A cross sectional study was conducted at DOTS Centre MIMS, Mandya. TB patients registered at DOTS Centre during the year 2018 were selected for the study. Verbal informed consent was taken from the TB patients and interviewed using pretested semi-structured questionnaire. Data analysis was done using descriptive statistics and chi square test.Results: Among the study population (n=90), 67 (74.4%) experienced ADR among which 47.7% took treatment for ADR and the remaining 52.3% patients were given reassurance. In this study, gastrointestinal manifestations (42.3%) were the most common adverse drug reaction (ADR). Of the TB patients who experienced ADR, 9.0% of them had interrupted ATT, however they completed full course of ATT.Conclusions: A considerable number of TB patients taking ATT experience ADRs and some of them may have to interrupt treatment. However, they need to be counselled or supervised with caution to complete their course of treatment to reduce the chances of treatment default and also reduce the occurrence of drug resistance.
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OBJECTIVE: The causal association of human papillomavirus (HPV) in uterine cervical cancer was well established and this oncogenic virus was reported to be a biomarker for overall recurrence and central pelvic recurrence. The objective of the present systematic review and meta-analysis was to assess the role of HPV DNA testing in early detection of recurrence among cervical cancer survivors after radiotherapy.METHODS: We performed a systematic review and meta-analysis by means of searching electronic databases for published articles between January 1984 and June 2018, on the basis of standard systematic review guidelines prescribed by major agencies namely Cochrane Collaboration (https://www.cochrane.org) and Campbell Collaboration (https://www.campbellcollaboration.org). The meta-analysis component was further modified appropriately for the synthesis of sensitivity and specificity results.RESULTS: A total of 1,055 cervical cancer cases who had received pelvic radiation with or without chemotherapy from ten cohort studies were evaluated. The overall pooled sensitivity and specificity of HPV DNA testing was 0.84 (95% confidence interval [CI]= 0.66–0.94) and 0.35 (95% CI=0.20–0.54) respectively. The positive likelihood ratio was 1.3 (95% CI=1.0–1.7) and the negative likelihood ratio was 0.45 (95% CI=0.18–1.10) with an estimated diagnostic odds ratio of 3 (95% CI=1–9).CONCLUSION: The screening for HPV DNA testing during follow-up facilitates early detection of recurrence after radiotherapy.
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Female , Humans , Cervix Uteri , Cohort Studies , Cooperative Behavior , DNA , Drug Therapy , Follow-Up Studies , Human Papillomavirus DNA Tests , Mass Screening , Odds Ratio , Oncogenic Viruses , Radiotherapy , Recurrence , Sensitivity and Specificity , Survivors , Uterine Cervical NeoplasmsABSTRACT
OBJECTIVE@#The causal association of human papillomavirus (HPV) in uterine cervical cancer was well established and this oncogenic virus was reported to be a biomarker for overall recurrence and central pelvic recurrence. The objective of the present systematic review and meta-analysis was to assess the role of HPV DNA testing in early detection of recurrence among cervical cancer survivors after radiotherapy.@*METHODS@#We performed a systematic review and meta-analysis by means of searching electronic databases for published articles between January 1984 and June 2018, on the basis of standard systematic review guidelines prescribed by major agencies namely Cochrane Collaboration (https://www.cochrane.org) and Campbell Collaboration (https://www.campbellcollaboration.org). The meta-analysis component was further modified appropriately for the synthesis of sensitivity and specificity results.@*RESULTS@#A total of 1,055 cervical cancer cases who had received pelvic radiation with or without chemotherapy from ten cohort studies were evaluated. The overall pooled sensitivity and specificity of HPV DNA testing was 0.84 (95% confidence interval [CI]= 0.66–0.94) and 0.35 (95% CI=0.20–0.54) respectively. The positive likelihood ratio was 1.3 (95% CI=1.0–1.7) and the negative likelihood ratio was 0.45 (95% CI=0.18–1.10) with an estimated diagnostic odds ratio of 3 (95% CI=1–9).@*CONCLUSION@#The screening for HPV DNA testing during follow-up facilitates early detection of recurrence after radiotherapy.
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In the present study, Pseudoxanthomonas species were isolated from rhizosphere soil samples of two selected medicinalplants, such as Alternenthera sessilis Linn. and Leucas aspera (Wild) Linn., which were collected from agriculturalfields at Kundagol, Dharwad, Karnataka. Pseudoxanthomonas sp. is Gram negative, aerobic, motile, non-spore formingrod shaped bacterium and it was designated as Pseudoxanthomonas strain RSA-23; it was found to possess broadspectrum of antimicrobial activity against pathogenic microorganisms. Furthermore, the most potent strain RSA-23was characterized by physiological, biochemical, and 16S ribosomal RNA gene sequencing. The 16S ribosomal RNAgene sequencing and analysis of phylogenetic tree showed 100% sequence similarity with Pseudoxanthomonas indica(KT204489). The methanol extract of Pseudoxanthomonas strain RSA-23 was analyzed through UV-spectroscopy andFourier transform infrared spectroscopy (FTIR). The UV-Vis. spectra revealed the presence of indole and the presenceof different functional groups, such as aldehydes, amines, and alkyl halides, were indicated by FTIR spectra.