Assessment of functional outcome following Duhamel retro-rectal pull-through surgery for Hirschsprung's disease: a follow-up study

Context: Hirschsprung's disease (HD) is one of the commonest problems requiring surgery in children. More than 95% of children present during new-born period, when they are treated with leveling colostomy and are followed with pull-through surgery a few months later, once the child has gained adequate weight to withstand a major surgery. The commonest pull through surgery done is the Duhamel retro-rectal pull-through (DRPT) repair. Settings and Design: This is a retrospective study of children who presented to one unit in our institute, a tertiary care referral hospital for children less than 12 years, with HD and underwent DRPT procedure during the period between July 2017 to June 2020. The children were evaluated after three years of follow-up for fecal incontinence and constipation. The study was conducted in children diagnosed with classical segment recto-sigmoid HD who underwent surgery. The children who were diagnosed with HD other than classical segment, who underwent primary pull through surgery and who underwent other repairs for HD were excluded from the study. Results: Thirty-two children underwent DRPT procedure during the study period. Of them, five (15.6%) children were lost on follow-up and one (3.1%) child had expired in the immediate post-operative period. Twenty-six children were included in the study. The bowel function score was calculated. The mean age of definitive surgery was 4.2 years. The follow-up period was a minimum of three years. Only two children had a "good" score of eighteen and above. Nineteen children had a "fair" score of 13-17. Five children had a "poor" score of less than thirteen, and among them, two had a "very poor" score of less than nine. The mean BFS was 13.72. Conclusions: Functional outcomes following Duhamel procedure are satisfactory, with 7.7% of children are in the fringe of requiring another surgery for constipation and pseudo-incontinence. (AU)

Nexus of ocular motility and dry eye

Purpose: To evaluate the effectiveness of vision therapy (VT) in patients with chronic presumed refractory dry eye disease (DED) and concurrent nonstrabismic binocular vision anomalies (NSBVAs). To propose an algorithmic approach to manage patients with refractory DED. Methods: Thirty?two patients with chronic (>1 year) presumed refractory DED and NSBVA were prospectively evaluated. The baseline dry eye evaluation and comprehensive orthoptic evaluation were done. VT was administered by a trained orthoptist for 2 weeks. The binocular vision (BV) parameters and percentage subjective improvement were assessed after the VT. Results: On evaluation, 12 patients (37.5%) had both DED and NSBVA, and 20 patients (62.5%) had only NSBVA. Twenty?nine patients (90.62%) showed significant improvement in BV parameters following VT. Binocular near point of accommodation (median, range) improved from 17 (8–40) to 12 (5–26) mm (P value < 0.0001), and near point of convergence (median, range) improved from 6 (3–33) to 6 (5– 14) (P value 0.004) with VT. Thirty?one patients (96.87%) reported symptomatic improvement after VT, and 62.5% of these showed more than 50% improvement in symptoms. Conclusion: The present study confirms the beneficial role of VT in the treatment of patients with DED with concurrent NSBVA. It is essential to diagnose and treat NSBVA in patients with DED to ensure complete relief of symptoms and patient satisfaction. As there is a significant overlap between symptoms of dry eye disease and that of NSBVA, a complete orthoptic evaluation is recommended in all patients presenting with refractory dry eye disease related symptoms

Phytochemical Investigation and in Vitro Antioxidant Activity of Panchavalkala Bark Extracts

Natural antioxidants have an important role in the prevention of many age-related diseases and promotion of health. Among natural antioxidants from plants, flavonoids and other phenolic compounds are potent antioxidants and chelating agents. Panchavalkala the barks of five trees i.e. Nyagrodha (Ficus benghalensis L.), Udumbara (Ficus racemosa L.), Ashwatha (Ficus religiosa L.), Plaksha (Ficus virens Aiton) and Parisha (Thespesia populnea (L.)Sol.ex Correa) are also known as Pancha Ksheeri Vrikshas in use since Vedic period. Barks of these trees are dried in shade and are used for different formulations (Pancha Kashaya Kalpanas), in different pathological conditions, especially as wound healing, gynecological disorders and etc. The plant samples were extracted using ethanol and water, and subjected for the phytochemical analysis. It was confirmed that samples contain many biologically active compounds like flavonoids, polyphenols, tannins, alkaloids, glycosides and terpinoids etc. The marker compound of each trial drug and the quantitative analysis has been carried out by high performance liquid chromatography. The antioxidant study was done by using in vitro method 1, 1­-diphenyl-2-picryl-hydrazyl (DPPH) radical scavenging assay. The marker compounds caffeic acid and gallic acid were quantified in each extract for their quality and efficacy. PVK barks showed high free radical scavenging activity as evidenced by the low IC50 values in DPPH (EE PVK- 20.46µg/ml, AE PVK-37.79µg/ml, EE T.poulenea-22µg/ml, AE T. poulenia- 23.31µg/ml AE F. benghalensis- 25.53µg/ml, EE F. benghalensis- 26.23µg/ml, EE F. religiosa - 34µg/ml). Quercetin- IC50 value 4.026µg/ml is used as standard. The results of the study demonstrated that PVK barks possess phyto-constituent’s viz. tannins, flavonoids, polyphenols etc. and has potential antioxidant activity. Thus these barks have good therapeutic potential as natural antioxidant and might be used in life style related conditions like hyperlipidemia, diabetes, obesity, cardiovascular disorders and etc.

Early Predictors of Hyperbilirubinemia in Full Term Newborn

Introduction: Predictive markers enabling Pediatricians to iden?fy which neonates will develop jaundice have mandatory for preven?on of severe hyperbilirubinemia. We aim to determine the cri?cal cord bilirubin and albumin levels and bilirubin/albumin ra?o. Design: This prospec?ve study included131fulltermnewborns. Hyperbilirubinemia can be predicted by Measuring cord bilirubin , albumin and bilirubin/albumin ra?o. Results: Neonatal hyperbilirubinemia (67.8%) had cord albumin level less than or equal to 2.7gm/dl. CordBilirubin/albumin ra?o cutoff value greater than 0.62 had a good predic?ve value with a sensi?vity of 100% and specificity of 88.36%, Conclusion: neonatal hyperbilirubinemia predictors are Cord BILIRUBIN/ALBUMIN ra?o , serum bilirubin and albumin.

The aging larynx: An anatomical perspective

There has been a striking increase in the geriatric population worldwide over the last few decades. As the aging process continues to alter functioning of all body systems, the human voice is also significantly affected. The senile voice is characterized by its changes in pitch, hoarseness, tremulousness, and breathiness with reduced harmonics and intensity. Such phonatory changes in the elderly may hinder effective communication, thus bringing down their confidence levels and impairing their quality of life. These characteristic features that distinguish the senile voice from younger speakers are accompanied by age?related changes in the organ of phonation, the larynx. The summative morphological and structural changes occurring in the elderly larynx have been referred to as “Presbylarynx.” The present review article is an attempt by the authors to explore the various anatomical age-related changes occurring in the larynx that may be responsible for altered vocal function in the elderly. An improved understanding of the anatomical basis of the aged voice can give further directions into the management of vocal disorders and improved speech performance in the elderly.

Expert survey on management of prostate cancer in India: Real?world insights into practice patterns

To gain insights on the diverse practice patterns and treatment pathways for prostate cancer (PC) in India, the Urological Cancer Foundation convened the first Indian survey to discuss all aspects of PC, with the objective of guiding clinicians on optimizing management in PC. A modified Delphi method was used, wherein a multidisciplinary panel of oncologists treating PC across India developed a questionnaire related to screening, diagnosis and management of early, locally advanced and metastatic PC and participated in a web朾ased survey (WBS) (n = 62). An expert committee meeting (CM) (n = 48, subset from WBS) reviewed the ambiguous questions for better comprehension and reanalyzed the evidence to establish a revote for specific questions. The threshold for strong agreement and agreement was ?90% and ?75% agreement, respectively. Sixty?two questions were answered in the WBS; in the CM 31 questions were revoted and 4 questions were added. The panelists selected answers based on their best opinion and closest to their practice strategy, not considering financial constraints and access challenges. Of the 66 questions, strong agreement was reached for 17 questions and agreement was achieved for 22 questions. There were heterogeneous responses for 27 questions indicative of variegated management approaches. This is one of the first Indian survey, documenting the diverse clinical practice patterns in the management of PC in India. It aims to provide guidance in the face of technological advances, resource constraints and sparse high?level evidence.

Mucormycosis in patients with COVID-19: A descriptive study at a tertiary care hospital in North Maharashtra

Introduction: 2019 novel coronavirus (2019-nCoV) or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first reported in Wuhan, in China, rapidly spread to other parts of the world forming a global pandemic. Secondary fungal or bacterial infections or coinfections are important challenges increasing the patients’ morbidity and mortality in COVID infection patients. The coronavirus disease-2019 (COVID-19) pandemic has led to increases in the cases of mucormycosis in India; rhino-orbito-cerebral mucormycosis is considered the most common type of mucormycosis, which is acquired by inhaling fungal spores in the paranasal sinuses. Objectives: The aims of this study were to assess the clinical and demographic profile of the patient with mucormycosis admitted to Government Medical College, Jalgaon and to identify the risk factors observed in the admitted patient with mucormycosis. Materials and Methods: The cross-sectional descriptive study was conducted among the patients admitted for the treatment of mucormycosis in Government Medical College and Hospital, Jalgaon, Maharashtra. A total of 91 patients admitted from April 15, 2021 to June 15, 2021 were enrolled as study participants. Result: More than half of the study participants were having complaints of swelling and pain over the cheek and face at the time of admission, whereas 20% were having pain in the nose, growth/swelling, and discharge from nose followed by toothache and loss of teeth in 13% of the study participants. More than 50% of patients were diabetic and 91% have a history of steroid use for the treatment of COVID-19. 57% of the study participants were having a history of diabetes. Conclusion: The physician should be more attentive for mucormycosis among the post-COVID-19 patients with diabetes patients and/or presenting with pain in the facial or orbital region or blackish or bloody nasal discharge.

A Study on Work Related Neck Pain among Bank Employees in Kolkata, India

Introduction: Varying prevalence of Work Related Neck Painhas been reported in different occupational groups. Employeesof Bank industries are subjected to various physical demands,prolonged sitting and standing postures which may lead toneck pain.Material and Methods: An observational cross sectionalstudy was conducted among 270 Bank employees of selectedNationalised banks from June-July 2018 using a pre designedpre tested structured questionnaire. Statistical analysisplan: For Descriptive statistics: mean± SD, for categoricalvariables: frequency(n) & proportion(%),to test association:chi square test.Results: About 47.41% suffered from WRNP. Significantassociation were found between WRNP and higher age,education below graduation, duration of employment, badposture, environment, mental stress, job pressure) andergonomics of work station, height of monitor screen, distancefrom mouse to edge of table etc.Conclusion: Sensitization of all bank employees about WRNPand its effects, training programme for good working postureand improvement of working environment may be addressed.

A Study of Placental Changes in Polycystic Ovarian Syndrome Patients with Gestational Diabetic Mellitus

Placenta is a vital organ for the development of foetus and maintenance of pregnancy. Placenta helps in the development and growth of foetus in uterus. In between maternal and foetal circulation the transfer of waste products and nutrients was done by the placenta which is a complex organ of a short life span. The diabetic pregnancy is characterised by numerous disturbances in foetal growth and development.METHODSA cross sectional study on placental changes in 60 pregnant women was done over a period of 18 months. Pregnant women in the age group of 25 years to 40 years who were suffering from polycystic ovarian syndrome (PCOS) were included in the study. Placental specimens were collected from obstetrics department and fixed overnight in 10% formalin. Thorough gross examination was done and few bits from the abnormal areas were given for microscopic examination. Routine histopathological process was followed for microscopic examination.RESULTSOut of 60 pregnant women with PCOS, seven patients were found to be having PCOS with gestational diabetes mellitus. These seven patients showed gross and microscopic changes in the placenta when compared with non-diabetic PCOS pregnant women.CONCLUSIONSPlacenta of diabetic women with PCOS showed both gross and microscopic abnormalities which may affect the growth and development of baby during intrauterine life.

Lessons Learnt in The Management of Acute Complications following Liver Injury in Children

Purpose@#Liver injuries constitute an important cause of hospital admissions, pediatric morbidity, and sometimes mortality. This study was undertaken to assess the spectrum of pediatric liver injuries with special emphasis on the management of acute complications. @*Methods@#This retrospective study used data from the Department of Pediatric Surgery, Bangalore Medical College, Bengaluru, India, between March 2013 and March 2019. All children between 1-18 years were included in the study (n = 33). Children were assessed with relevance to age, sex, mode of injury, hemodynamic stability at admission, need for blood transfusions, surgery, radiological investigations, complications, total number of days of stay in hospital, and mortality. @*Results@#There were 27 (81.8%) males and 6 (18.18%) were females. The most common cause for injury was a road traffic accident (60.6%). The majority (nearly 65%) of pediatric liver injuries were Grade II and III. There were 4 children who had post traumatic complications including 2 pseudoaneurysms, 1 inferior vena cava thrombus, and 1 bile leak with a biloma formation which were managed appropriately. @*Conclusion@#Timely and appropriate radiological evaluation is required for assessments of complications. The majority of complications can be managed conservatively, and minimally invasive techniques like endoscopic retrograde cholangiopancreatography is helpful in the management of complications.

Lessons Learnt in The Management of Acute Complications following Liver Injury in Children

Purpose@#Liver injuries constitute an important cause of hospital admissions, pediatric morbidity, and sometimes mortality. This study was undertaken to assess the spectrum of pediatric liver injuries with special emphasis on the management of acute complications. @*Methods@#This retrospective study used data from the Department of Pediatric Surgery, Bangalore Medical College, Bengaluru, India, between March 2013 and March 2019. All children between 1-18 years were included in the study (n = 33). Children were assessed with relevance to age, sex, mode of injury, hemodynamic stability at admission, need for blood transfusions, surgery, radiological investigations, complications, total number of days of stay in hospital, and mortality. @*Results@#There were 27 (81.8%) males and 6 (18.18%) were females. The most common cause for injury was a road traffic accident (60.6%). The majority (nearly 65%) of pediatric liver injuries were Grade II and III. There were 4 children who had post traumatic complications including 2 pseudoaneurysms, 1 inferior vena cava thrombus, and 1 bile leak with a biloma formation which were managed appropriately. @*Conclusion@#Timely and appropriate radiological evaluation is required for assessments of complications. The majority of complications can be managed conservatively, and minimally invasive techniques like endoscopic retrograde cholangiopancreatography is helpful in the management of complications.

Assessment of Lifestyle Practices and Nutritional Status among Undergraduate Medical Students

Background andObjectives: Overweight and obesity are not only the biggest problem among the middle-aged but also among children, teenagers and young adults. Early detection of the factors causing obesity, in turn, helps in the prevention of its complications. The objectives of the study were to assess the various lifestyle practices among medical students and to correlate the relationship between the nutritional status and biochemical parameters.Methods:A cross-sectional -study was conducted on MBBS students studying at Mandya Institute of Medical Sciences (MIMS), Mandya, Karnataka, India. Self-administered questionnaires were given to the students followed by the recording of their anthropometric measurements. Nutritional status was assessed using the Body Mass Index (BMI). Fasting blood sample was collected from the student and analysed the biochemical parameters.Results: Out of 325 students, 48.9% were male students and 51.1% were female students. Itwas found that a higher percentage of female students (53%) was on a balanced diet as compared to male students (47.2%). The daily consumption of fruits and vegetables were less amongst students of both genders. Mean values of Fasting Blood Sugar (FBS), Total Cholesterol (TC), Triglyceride (TG) and Low-Density Lipoprotein (LDL-C) were higher among male students as compared to female students. Mean values of few biochemical parameters like FBS, TC, TG and LDL-C were higher amongst obese students along with a corresponding decrease in High-Density Lipoprotein (HDL-C).Conclusion:Our study showed that unhealthy dietary and lifestyle practices were associated with increased levels of various biochemical parameters and it was more common amongst male students. Increased biochemical parameters like FBS, TC, TG and LDL-C with the corresponding decrease in HDL-C is an alarming sign for increased risk of developing cardiovascular disease among the younger age group.

Study of Bone Mineral Density, Vitamin-D and Body Mass Index in Asthmatic ACOS and COPD Cases: Those who are on Prolonged (more than 3 Years) use of Inhaled Corticosteroids

Introduction: Inhaled corticosteroids are the prime choice of treatment for Asthma, ACOS, and COPD cases, but using inhaled corticosteroids with the influencing factors for a longer duration may cause cachexia, skeletal muscle abnormalities, and metabolic syndromes. Objectives: To determine whether the use of inhaled corticosteroids has a harmful effect on bone, in case of Asthma, ACOS, and COPD. To assess the correlation between low bone mineral density with low vitamin D levels and low body mass index. To assess the fracture risk with the effect of inhaled corticosteroids in asthma, ACOS and COPD cases. Methods: A total of 260 subjects (123 males and 137 females) aged ≥ 25 years attended the routine check-up for NRI Institute of Medical Sciences, Visakhapatnam. The pulmonology department was grouped into 4. Data was collected and filed by using data collection sheet, measured bone mineral density with the ultra-sonogram machine, did investigative procedures to know the blood calcium and vitamin-D levels. Results: Our study revealed that all quantitative and qualitative parameters were measured and analyzed with the SPSS software version 18, (vitamin-D, bone mineral density, body mass index, allergies, family, smoking histories and others) obtained a statistically significant p-value. Conclusion: Effect of disease and inhaled corticosteroids use respiratory diseases for a longer duration or in high doses resulting in decreased bone mineral density along with the decreased body mass index.

An Experimental Evaluation Of Haritamanjari (acalypha Indica Linn) For Mutrala Karma W.s.r To Diuretic Activity

Diuretics are widely employed drugs used to treat extra cellular fluid volume expansion caused due to renal, cardiac, liver disorders etc. These diuretics are effective but have side effects. Acalypha Indica Linn is a herb of Euphorbiaceae family, found throughout India as a weed. Many studies have been carried out but sufficient data is not available to establish its diuretic activity. Hence the study is focused on the assessment of Harita Manjari for its diuretic action in animal model. Methods: The trial drugs are administered for 7 days prior to the day of evaluation of diuretic action; the rats were individually placed in the metabolic cages to collect urine. The volume of the urine collected in graduated vials was measured after 6 hours and expressed in terms of ml/100gm of body weight. Results: The invivo study demonstrated that crude suspension of Harita Manjari in a dose of 450mg/kg has significant diuretic activity. The statistical analysis has been carried out and results on continuous measurements are presented on Mean ± SEM were calculated. Urine output, pH and urine electrolytes were compared with control groups by one-way ANOVA followed by Dunnett’s multiple comparison test. The P Value <0.05 were considered as statistically significant. Conclusion: Order of diuresis: Crude suspension >Alcoholic extract >Aqueous extract.

Combined Orthodontics And Surgical Approach To Class Iii Malocclusion With Anterior Open Bite In Adults

Skeletal anterior open bite with Class III malocclusion in adults is one of the most difficult malocclusions to treat. Surgical intervening is a must, along with orthodontics in such complex cases. The most effective treatment option in adult patients with Class III malocclusion and the skeletal anterior open bite is surgical repositioning of the maxilla or both jaws. The present case report describes the treatment protocol for Class III malocclusion with an anterior open bite in adult, a novel orthodontic- surgical approach. A 24-year old male patient with a Class III malocclusion, anterior open bite (skeletal), poor facial aesthetics, mandibular and chin protrusion. The objective was to achieve ideal overjet and overbite, to achieve class 1 incisor, canine and molar relation. To correct anterior open bite and achieve Class I skeletal jaw bases and to achieve esthetically pleasing profile and functionally stable occlusion. Therefore, by correction of the dental and skeletal jaw relationship, we hoped to improve the patient’s self- esteem, confidence and improved oral health quality of life.

A prospective observational pharmacovigilance study of adverse drug reaction monitoring in patients of tuberculosis receiving category I and II treatment regimens at tertiary care hospital

Background: First line Anti-TB therapy with rifampicin, isoniazid, pyrazinamide, and ethambutol / streptomycin is very effective. However, major adverse reactions to antituberculous drugs can cause significant morbidity and mortality. One of the main reasons for non?adherence to anti?TB therapy (ATT) is ADRs, even under DOTS. Present study was carried out in tertiary care hospital. The objective of the study was to evaluate types and frequency of ADRs in intensive and continuation phase of category I and II Anti-TB medication.Methods: A prospective observational study conducted in Department of TB- Chest and Medicine, Govt. Medical College, Aurangabad, Maharashtra, India. All the TB patients reporting at DOTS Center of institute were enrolled and monitored for ADRs. The causality and severity of the reactions were determined using Naranjo algorithm and Hartwig questionnaire.Results: Total, n = 241 tuberculosis patients on DOTS therapy were enrolled for the study. Out of 241 patients, 17 were dropouts so 224 patients assessed for ADRs. 127 (56.69%) developed adverse drug reactions. The higher numbers of ADRs were observed in age group 31-40 yrs followed by 21-30 yrs, ADRs were more common in men. Pulmonary TB (73.66%) cases were more common than extra pulmonary TB. Majority of adverse drug reactions were Gastrointestinal (GI) problems (30.92%), followed by Liver dysfunction and Hepatotoxicity (20.39%) and skin problems (17.10%). The causality of ADRs, in majority cases were found to be Probable (56.57%). Around 19 patients require treatment interruption and most of the patients were managed with supportive medication without removing anti tubercular drug from regimen.Conclusions: ADRs are major limiting factor for completion of drug therapy under RNTCP and occurrence of drug resistance which requires attention of all health care professionals.

‘Obesageing’: Linking obesity & ageing

Obesity is one of the leading causes of preventable mortalities in many parts of the globe. The rise in geriatric population due to better treatment opportunities has also emerged as a major public health challenge. Both of these health challenges have impacted developed as well as developing countries. Obesity is attributed as a powerful risk factor of a variety of health problems such as cardiovascular diseases, hypertension, type 2 diabetes, dementia, neuropsychiatric diseases and many more. On the other hand, ageing is a natural process involving a gradual decline in physiological functions and is associated with similar co-morbidities as obesity. This review discusses about the commonalities (termed as ‘Obesageing') between the pathological phenomenon of obesity and normal physiological process of ageing. A unique rodent model of obesageing has been developed (WNIN/Ob) that has characteristics of morbid obesity as well as premature ageing. Such a novel animal model would facilitate the understanding of the complex interplay of different mechanisms that are common to obesity and ageing and help to devise strategies in future to tackle the growing burden of obesity and ageing.

Research orientation in Ayurveda educational institutions: Challenges and the way forward

This paper examines the scenario of research orientation in Ayurveda educational institutions of India.We demonstrate through the data obtained by searching the SCOPUS that the actual research outputby these institutions is not very significant in terms of number of publications. While a lack of researchexpertise and infrastructure is one contributing factor to this status, a lack of questioning attitude is morecrucial one. Mushrooming of new colleges, laxity in regulations, corruption, lack of atmosphere forethical and quality research make the problem more complex. We show, with the help of SCOPUS Data,that the recent trend of establishing stand-alone institutions of Ayurveda may not help in invigoratingresearch activities since the research contributions from such institutions have always been very poor.Instead, we suggest that existing stand-alone institutions of Ayurveda be merged with other establishedCentral/State universities or other Medical colleges. The data demonstrates that the research output hasbeen always significant when an institution has many experts working in different streams of sciencewithin, than when the institutions have only Ayurveda experts. We also take up the question of designingthe clinical trials that are suitable for Ayurveda and propose an algorithm that may be considered forresearch in educational institutions, at least at doctoral level. We further enlist a set of recommendationsthat could potentially change the scenario. Evidence-informed policy making, inducting clinicians intothe education system, making the curricula more attractive by including recent advances, introducingefficient faculty training programs, and rigorous implementation of the existing regulations - are some ofthe key recommendations we have made.© 2018 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services byElsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).