Human Leukocyte Antigen-DQ Genotyping in Pediatric Celiac Disease / 대한소아소화기영양학회지

Purpose@#The purpose of this study was to determine the pattern of human leukocyte antigen (HLA)-DQ genotype in children diagnosed with celiac disease (CD) (biopsy proven), and to compare this with a control group; and secondarily, to correlate HLA genotypes with clinical profiles of CD. @*Methods@#This cross-sectional comparative observational study included 26 controls and 52 patients diagnosed with CD who presented at Sir Padampat Mother and Child Health Institute, Jaipur, from May, 2017 to October, 2018. HLA DQ genotype was assessed for each patients and correlated with clinical profiles. @*Results@#HLA DQ2/DQ8 genotypes were significantly more common in CD (present in 100.0% cases) than in controls (23.1%) in Northern India (Rajasthan). When HLA DQ2.5 and DQ8 were present together, individuals had significantly more atypical presentations and severe findings on duodenal biopsy. Similarly, patients with the HLA DQ 2.5 genotype were also predisposed to more severe endoscopic findings, while HLA DQ2.2 predisposed them to less severe biopsy findings. HLA DQ8 was significantly associated with later age at diagnosis (>5 years) and shorter stature. The highest HLA DQ relative risk (RR) for CD development was associated with HLA DQ2.5 and DQ2.2 in combination, followed by HLA DQ2.5 and DQ8 in combination, while HLA DQx.5 and HLA DQ2.2 together had the lowest risk. @*Conclusion@#HLA DQ2/DQ8 genotypes are strongly associated with pediatric CD patients in northern India. These genotypes and their combinations may be associated with different clinical presentations of CD, and may help predict severity of CD.

Nidana and Management of Lifestyle Disorders

Lifestyle disorders are the diseases linked with one’s lifestyle. Nowadays, lifestyle disorders are becoming more widespread and affecting a majority of the population and posing a huge public health threat around the world. According to the World Health Organization (WHO), lifestyle disorder is a subgroup of non-communicable diseases (NCDs) and accounts for around 71 percent of all deaths worldwide. Lifestyle disorders are caused mostly by poor diet and lack of physical activity. Distracting the people from physical exercise and their attraction towards sedentary lifestyle can lead to a variety of health problems including chronic non-communicable diseases with life-threatening issues. Hypertension, diabetes, PCOS, cancer, arthritis, obesity, insomnia, depression are the diseases which can be taken under lifestyle disorders. Ayurveda, science of life, aims in fundamental goal of maintaining health of healthy people and treatment of disease in sick one’s. To sustain a healthy and joyful life (Hitaayu & Sukhaayu), Ayurveda has a number of different principles and regimens including Ahara and Vihar (dietary habits and daily routine), Dinacharya (daily regimen), Ratricharya (night regimen), Ritucharya (seasonal regimen), Panchkarma (five detoxification and bio-purification therapies), Rasayana (rejuvenation), Sadvritta paalan (ideal habits) and Aachara Rasayana (code of conduct). Hence, lifestyle disorders can be well managed through Ayurveda by adopting its different principles and regimens.

Investigation of the influence of clathrate hydrate crystals on the structuring of homeopathic high dilutions

High dilutions (HD) of drugs used in homeopathy are mostly too dilute to contain original drug molecules. But evidences support their specific biological and therapeutic effects. The reason behind this is thought to be water structure characteristic of the original drug. Spectroscopic studies indicate that the specific water structure in HDs can be resolved into free water molecules, hydrogen bonding strength of water hydroxyl, number of hydrogen bonds and clathrate hydrate crystals (CHC). HDs are prepared in EtOH water solution by serial dilution and mechanical agitation, and are called potencies. The objective of the present study is to further confirm the presence of CHCs in the two potencies of three drugs. Electronic spectra of the HDs of the potencies indicate two broad peaks and marked difference in intensities of absorption. Furior Transform Infrared (FT-IR) spectra of the test potencies and their control show difference in intensity shift and contour shape of OH stretching and bending bands. All the experimental data indicate the presence of CHCs in varying amounts in the test potencies.

High Dilutions of Drugs show Distinct Variation from each other in their Electronic Spectra

Drugs at high dilution (HD) produce therapeutic effect on man, animals and plants. Experimental evidence shows that free water molecules and hydrogen bond strength of OH groups constitute the physical basis of HDs which are otherwise devoid of original drug molecules. HDs are produced in aqueous EtOH by serial dilution of a substance with mechanical agitation or succussion in each step, and are called potencies. Three potencies 6 cH, 12 cH and 30 cH of two drugs Anacardium orientale and Natrum muriaticum(NaCl) and their mother tincture (MT) are used in this study. Electronic spectra of these MTs and potencies, all in 90% EtOH, were taken in the wavelength region of 190 nm ­350 nm. The objective is to find out any additional physical-chemical entities in potencies besides the aforesaid two factors. It was reported earlier that charge transfer (CT) interaction accompanies potentization of drugs. This study focused on the CT interaction. The results indicate that spectral pattern and absorbance intensities of the test samples vary from each other. Natm 6cH (absorbance 0.30 at 196.53nm), 12cH (abs. 0.06 at 196.53nm) and 30cH (abs. 1.32 at 196.5nm). Anac 6cH (abs. 0.33 at 203nm), 12cH (abs. 0.61 at 208nm) and 30cH (abs. 0.09 at 200.67nm). The spectrum of each potency shows two peaks. The 2nd peak at higher wave length belongs to CT interaction. Anac 6cH suc, 7cH unsuc. Insersections at 197.14nm with abs. 0.05, and 290nm with abs. 0.01. Anac 12cH suc, 13cH unsuc. Intersections at 196.93nm with abs. 0.06, and 273nm with abs. 0.00. Anac 30cH suc, 31cH unsuc. Intersections at 194.42nm with abs. -0.05, 238.03nm with abs. -0.01, 252.15nm with abs. -0.002, and 261nm with abs. 0.004. Natm 6cH suc, 7cH unsuc. Intersection at 199.44nm with Abs -0.11. Natm 12cH suc, 13cH unsuc. Instersection at 200.48nm with abs. -0.11. Natm 30cH suc, 31cH unsuc. Intersection at 204.24nm with abs. -0.08. Potentization involves CT interaction in consecutive potencies. Water and EtOH do not form a homogeneous mixture and have aggregates of EtOHand water molecules. CT interactions occur in these individual aggregates and are mostly inter molecular within EtOH or water. These aggregates vary from each other in the test samples. The spectra of test samples were analysed for margin of error (MOE). The MOE is very small (0.001-0.002%), and for this reason the difference between the spectra is significant. Besides that the intersection between consecutive spectra vary in number and position. It is concluded that water and EtOH aggregates and their relative distribution constitute additional physical-chemical basis of potencies.

A comprehensive yoga programme for weight reduction in children & adolescents with obesity: A randomized controlled trial

Background & objectives: Obesity is a rising pandemic in childhood. There is scarcity of evidence on the efficacy of yoga in achieving weight loss in overweight/obese children. The objective of this study was to assess the efficacy of family-based comprehensive yoga intervention in the reduction of body mass index (BMI) in overweight/obese children, in comparison to standard dietary and lifestyle counselling and control group. Methods: This was an open-label randomized controlled study. Children aged 8-15 yr who were overweight or had obesity were randomized to one of the three arms for 18 wk; standard weight management (group 1), yoga with dietary modification (group 2) and control (no intervention; group 3). Reduction in BMI and improvement in physiological, biochemical and psychological parameters from baseline to 18 wk was compared between the three arms. Late follow up was also done at 6-12 months. Results: A total of 165 children with mean±standard deviation (SD) age of 11.6±1.8 yr and mean BMI 26.3±4.2 kg/m2 were enrolled. Outcome analysis at 18 wk was performed for 109 children. Improved diet quality and reduced intake were observed in both intervention arms. The median (IQR) reduction in BMI in standard and yoga arms was similar [?1.4 (?3.1, ?0.5) kg/m2 and ?1.2 (?2.3, ?0.6) kg/m2, respectively], while it increased by +0.3 (?0.3, 0.1) in the control arm. In the yoga arm, mean systolic BP reduced from 118 (10) to 114 (8) mmHg, (P=0.019). In the standard arm, significant improvement in psychological scores was noted. In group 3, the mean fasting glucose increased from 93±10 to 102±12 mg/dl (P<0.001). Interpretation & conclusions: The findings of the present study suggest that yoga in conjunction with dietary modification is equally effective as the standard weight management for BMI reduction in the paediatric age group.

Comparative Evaluation of Duration of Extraction Space Closure and Degree of Root Resorption with Conventional and Self-Ligation Brackets

Introduction: Determination of difference between conventional and passive self?ligating brackets (SLBs) in respect of extraction space closure, patient perception and root resorption. Material and Methods: Eighty patients were divided into four groups of 20 each with age?sex?matched control using a simple randomisation technique and allocation concealment with a closed opaque envelope method. Group 1 consisted of conventional brackets with Connecticut New Archwire (CNA) wire mushroom loop, group 2 consisted of conventional brackets with TAD (AbsoAnchor, Korea) supported retraction, group 3 consisted of passive SLB with CNA archwires (Libral Traders, India) mushroom loop and group 4 consisted of passive SLB brackets with TAD (AbsoAnchor, Korea) supported retraction. The rate of retraction, root resorption and patient satisfaction were assessed. All conventional brackets (Orthox, USA) and passive SLBs (CaptainOrtho, India) had 0.018 Roth prescriptions with a slot size of 0.018 × 0.025. Results: Retraction was the fastest in group 2 with a mean of 1.266 ± 0.14 mm/4 week and a duration of 23.40 weeks. Similarly, group 4 showed the most sluggish movement with a mean of 1.182 ± 0.80 mm/4 weeks with a total duration of 25 weeks; howeverdifferencesce among groups were not statistically significant (P = 0.470). Conclusion: SLBs have advantage of better patient comfort, less pain and reduced chairside time. Though the present study found increased treatment duration with SLB along with friction mechanics, refuting the previous claims of reduced friction with SLBs, however, the difference was not statistically significant and results have to be extrapolated with caution and experience considering other advantages of SLBs.

High dilutions of a drug of COVID-19 origin show difference in ranks

High dilutions (HDs) of drugs, used in Homeopathy, are prepared in aqueous EtOH (ethanol) through serial dilution accompanying mechanical agitation or succussion, and are called potencies. The potencies from the rank 12 onwards are too dilute to contain any original drug molecules. Do the potency ranks show any difference from each other? Do serial dilution and succussion contribute to the difference in potency ranks? This study aims to address these two questions. The throat swab of a Covid-19 patient was preserved and diluted with aqueous EtOH 90% to prepare the mother tincture (MT) and five different potencies of Covid named Covidinum. These potencies and their solvent media were analysed by electronic and vibrational spectroscopy. Charge transfer (CT) and proton transfer interactions occur during preparation of the potencies. The FT-IR spectra of all the test samples after normalization show difference from each other with respect to O-H stretching and bending (v2) bands. Serial dilution and succussion contribute to the observed difference in ranks and CT interactions.

Effects of ultra high dilution of paraquat 30 ch on growth, chlorophyll content and yield of rice crop

The application of synthetic fertilizers reduces the natural fertility of the soil and contaminates groundwater. Some photosynthesis inhibitors at ultra-high dilution (UHD) increase photosynthesis, growth, and yield of crops. A weedicide Paraquat at UHD enhanced the growth and yield of potatoes in fields. The objective is to see whether the UHD of Paraquat is also effective on rice. This weedicide was serially diluted with distilled water and manually succussed in 30 steps following the preparation of homeopathic dilutions called potencies. In this way, the 30thpotency of Paraquat called Paraquat 30 cH was prepared and preserved in 90 % ethanol. Paraquat 30 cH was diluted with water 1:1000 (v/v) and sprayed on rice plants in a field measuring 0.3125 acres. The control plot of the same area was situated 300 meters away from the test plot. Three treatments were given at an interval of 7 days. The treated plot showed increased growth, chlorophyll content, and rice yield significantlycompared to control. The UHD of the weedicide produced precisely the opposite effect of the crude material on plants. The increased growth and yield of rice by Paraquat 30 cH may be due to the enhancement of photosynthesis of treated plants. The UHD of Paraquat increased the yield of rice by 19.35% over the control.

Effects of maxillary expansion on hearing and voice function in non-cleft lip palate and cleft lip palate patients with transverse maxillary deficiency: a multicentric randomized controlled trial / Efeitos da expansão maxilar na função auditiva e vocal em pacientes sem fissura labiopalatina e com fissura labiopalatina e deficiência maxilar transversa: um estudo controlado multicêntrico e randomizado

Abstract Introduction The association between the treatment of transverse maxillary deficiency and the recovery of hearing and voice functions has gained attention in recent years. Objective This prospective controlled trial aimed to evaluate the effects of rapid maxillary expansion on hearing and voice function in children with non-cleft lip palate and bilateral cleft lip palate with transverse maxillary deficiency Methods 53 patients (26 non-cleft and 27 bilateral cleft lip palate; mean age, 11.1 ± 1.8 years) requiring rapid maxillary expansion for correction of narrow maxillary arches were recruited for this trial. Eight sub-groups were established based on the degree of hearing loss. Pure-tone audiometric and tympanometric records were taken for each subject at four different time periods. The first records were taken before rapid maxillary expansion (T0), the second after expansion (T1) (mean, 0.8 months), the third after three months (T2) (mean, 3 months) and the fourth at the end of retention period (T3) (mean, 6 months). ANOVA and Tukey HSD post-hoc tests were used for data analysis. Additionally, voice analysis was done using an updated PRAAT software program in a computerized speech lab at T0 and T2. A paired-samplet-test was used for comparisons of mean values of T0 and T2 voice parameters within both groups. Results Rapid maxillary expansion treatment produced a significant increase in the hearing levels and middle ear volumes of all non-cleft and bilateral cleft lip palate patients with normal hearing levels and with mild conductive hearing loss, during the T0-T1, T1-T2, T0-T2, and T0-T3 observation periods (p < 0.05). The significant increase was observed in right middle ear volumes during the T0-T1, T0-T2 and T0-T3 periods in non-cleft patients with moderate hearing loss. For voice analysis, significant differences were observed only between the T0 and T2 mean fundamental frequency (F0) and jitter percentage (p < 0.05) in the non-cleft group. In the cleft group, no significant differences were observed for any voice parameter between the T0 and T2 periods. Conclusion Correction of the palatal anatomy by rapid maxillary expansion therapy has a beneficial effect on both improvements in hearing and normal function of the middle ear in both non-cleft and bilateral cleft lip palate patients. Similarly, rapid maxillary expansion significantly influences voice quality in non-cleft patients, with no significant effect in BCLP patients.

Resumo Introdução A associação entre o tratamento da deficiência maxilar transversa e a recuperação das funções auditivas e vocais ganhou atenção nos últimos anos. Objetivo Avaliar os efeitos da expansão rápida da maxila na função auditiva e vocal em crianças sem fissura labiopalatina e com fissura labiopalatina bilateral com deficiência maxilar transversa. Método Foram recrutados para este estudo 53 pacientes (26 sem fissura e 27 com fissura labiopalatina bilateral; média de 11,1 ± 1,8 anos) que necessitam de expansão rápida da maxila para correção de arcos maxilares estreitos. Oito subgrupos foram estabelecidos com base no grau de perda auditiva. Registros audiométricos e timpanométricos de tons puros foram obtidos para cada indivíduo em quatro períodos. Os primeiros registros foram obtidos antes da expansão rápida da maxila (T0), o segundo após a expansão (T1) (média de 0,8 meses), o terceiro após três meses (T2) (média de 3 meses) e o quarto no fim do período de retenção (T3) (média de 6 meses). Anova e o teste post-hoc de Tukey HSD foram usados para análise dos dados. Além disso, a análise da voz foi feita com um programa PRAAT atualizado em um laboratório de fala computadorizadaem T0 e T2. Foi usado um teste t de amostras pareadas para comparação dos valores médios dos parâmetros de voz em T0 e T2 nos dois grupos. Resultados O tratamento com expansão rápida da maxila produziu um aumento significativo nos níveis auditivos e nos volumes da orelha média de todos os pacientes sem fissura e pacientes com fissura labiopalatina bilateral e níveis auditivos normais e com perda auditiva condutiva leve, durante os períodos de observação T0-T1, T1-T2, T0-T2 e T0-T3 (p < 0,05). Aumento significativo foi observado nos volumes da orelha média direita durante os períodos T0-T1, T0-T2 e T0-T3 em pacientes sem fissura e com perda auditiva moderada. Para a análise de voz, diferenças significantes foram observadas apenas entre a frequência fundamental média T0 e T2 (F0) e a porcentagem de jitter (p < 0,05) no grupo sem fissura. No grupo com fissura, não foram observadas diferenças significantes para nenhum parâmetro de voz entre os períodos T0 e T2. Conclusão A correção da anatomia palatal pela expansão rápida da maxila tem um efeito benéfico tanto na melhoria da audição quanto na função normal da orelha média em pacientes sem fissura e com fissura labiopalatina bilateral. Da mesma forma, a expansão rápida da maxila influencia significativamente a qualidade da voz em pacientes sem fissura, sem efeito significativo em pacientes com fissura labiopalatina bilateral.

Dystonia Responsive to Dopamine: POLG Mutations Should Be Considered If Sensory Neuropathy Is Present

The POLG gene encodes mitochondrial DNA polymerase, and mutations in this gene cause a spectrum of disorders related to mitochondrial DNA depletion or deletion. Dystonia has only rarely been reported as an early and prominent manifestation of POLG mutations. We report a case of a 30-year-old male presenting with lower limb dystonia with peripheral neuropathy and demonstrate that the dystonia was levodopa responsive (with video findings). Whole-genome sequencing revealed biallelic variants in the POLG gene: a known pathogenic variant [NM_001126131.2:c.2209G>C (p.Gly737Arg)] and a novel likely pathogenic variant [NM_001126131.2:c.3305A>C (p.Gln1102Pro)]. A genetic diagnosis was made before the appearance of more readily recognizable features of mitochondrial disease, allowing us to avoid invasive tissue biopsies or potentially deleterious treatments, such as sodium valproate. A POLG-related disorder should be suspected in cases of dystonia with peripheral neuropathy, and this diagnosis may have implications for further investigations and management.

Dystonia Responsive to Dopamine: POLG Mutations Should Be Considered If Sensory Neuropathy Is Present

The POLG gene encodes mitochondrial DNA polymerase, and mutations in this gene cause a spectrum of disorders related to mitochondrial DNA depletion or deletion. Dystonia has only rarely been reported as an early and prominent manifestation of POLG mutations. We report a case of a 30-year-old male presenting with lower limb dystonia with peripheral neuropathy and demonstrate that the dystonia was levodopa responsive (with video findings). Whole-genome sequencing revealed biallelic variants in the POLG gene: a known pathogenic variant [NM_001126131.2:c.2209G>C (p.Gly737Arg)] and a novel likely pathogenic variant [NM_001126131.2:c.3305A>C (p.Gln1102Pro)]. A genetic diagnosis was made before the appearance of more readily recognizable features of mitochondrial disease, allowing us to avoid invasive tissue biopsies or potentially deleterious treatments, such as sodium valproate. A POLG-related disorder should be suspected in cases of dystonia with peripheral neuropathy, and this diagnosis may have implications for further investigations and management.

Setting up a lung stereotactic body radiotherapy service in a tertiary center in Eastern India: The process, quality assurance, and early experience

Context: Stereotactic body radiotherapy (SBRT) is increasingly being used for early-stage lung cancer and lung oligometastases. Aims: To report our experience of setting up lung SBRT and early clinical outcomes. Settings and Design: This was a retrospective, interventional, cohort study. Subjects and Methods: Patients were identified from multidisciplinary tumor board meetings. They underwent four-dimensional computed tomography-based planning. The ROSEL trial protocol, the Radiation Therapy Oncology Group (RTOG) 0236, and the UK-Stereotactic Ablative Body Radiotherapy Consortium guidelines were used for target volume and organs-at-risks (OARs) delineation, dosimetry, and plan quality assessment. Each SBRT plan underwent patient-specific quality assurance (QA). Daily online image guidance using KVCT or MVCT was done to ensure accurate treatment delivery. Statistical Analysis Used: Microsoft Excel 2010 was used for data analysis. Results: Fifteen patients were treated to one or more lung tumors. One patient received helical tomotherapy in view of bilateral lung oligometastases at similar axial levels. All the remaining patients received volumetric modulated arc therapy (VMAT)-based treatment. The prescription dose varied from 40 to 60 Gy in 5–8 fractions with alternate-day treatment. The mean and median lung V20 was 5.24% and 5.16%, respectively (range, 1.66%–9.10%). The mean and median conformity indexes were 1.02 and 1.06, respectively (range, 0.70–1.18). After a median follow-up of 17 months, the locoregional control rate was 93.3%. Conclusions: SBRT was implemented using careful evaluation of OAR dose constraints, dosimetric accuracy and plan quality, patient-specific QA, and online image guidance for accurate treatment delivery. It was safe and effective for early-stage nonsmall cell lung cancer and lung metastases. Prospective data were collected to audit our outcomes

Analysis of Ultrasonography and Diagnostic Laparoscopy in Nonpalpable Testis

Undescended testis is one of the common disorders encountered in a male child. In nonpalpable testis, ultrasound often fails to locate the testis. Hence, diagnostic laparoscopy has recently replaced it in the management of nonpalpable testis. METHODSThis is a cross-sectional study conducted among all patients who presented between October 2018 and March 2020 with a nonpalpable testis and in whom ultrasound could not locate the testis. Analysis of ultrasound and diagnostic laparoscopy in nonpalpable testis was done. Statistical analysis was done by calculating accuracy, sensitivity, and specificity for selected tests. RESULTS20 patients were included in the study. Most of them (95%) presented after 1 year. Most cases were unilateral 80%; left-sided in 45%, right sided in 35%, and 4 (20%) were bilateral. In 25% cases, the testis was located at the deep inguinal ring, and in 70% cases, it was intra-abdominal, although in 2 cases the testes were tiny like a nubbin. In 1 case, the vessels and vas entered the deep inguinal ring; hence inguinal exploration was done; however, as only a nubbin was found on exploration, orchidectomy was done. In 1 patient inguinal exploration done, whereas other patients were managed laparoscopically. In 2 patients, laparoscopic orchidectomy and in others, laparoscopic-assisted orchiopexy were done. CONCLUSIONSLaparoscopy is superior to ultrasound because of increased sensitivity in localizing a nonpalpable testis, time- and cost-effectiveness, and diagnostic as well as therapeutic options.

Metronomic palliative chemotherapy in locally advanced, recurrent and metastatic head-and-neck cancer: A single-arm, retrospective study of a regional cancer center of North India (Asia)

Background: Head-and-neck cancer is the most common cancer in developing countries of Southeast Asia. Most of the patients present to the hospital in advanced stage and have a poor prognosis. This study aims to evaluate the efficacy and toxicity profile of oral metronomic chemotherapy (MCT) in the form of methotrexate and celecoxib in locally advanced, recurrent and metastatic head-and-neck cancers. Materials and Methods: This was a single-arm retrospective observational study that included posttreatment patients with locally advanced, recurrent and metastatic disease in the year 2016 (January 1, to December 31, 2016). A total of 84 patients warranting palliative chemotherapy but not willing to take intravenous chemotherapy were included in the study. The oral MCT schedule consisted of oral celecoxib (200 mg twice daily) and oral methotrexate (15 mg/m2/week). Response evaluation was done using the Response Evaluation Criteria in Solid Tumors criteria version 1.1, and toxicity profile was assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03. Descriptive statistics and Kaplan–Meier analysis were performed. Results: Eighty-four patients, 68 males and 16 females, with a median age of 62 years (range: 35–80 years), were enrolled in the study to receive oral MCT. The Eastern Cooperative Oncology Group performance status was 0–1 in 62 patients and 2–3 in 22 patients. The primary sites of disease were buccal mucosa (18), tongue (22), tonsil (24), lower alveolus (7), hypopharynx (10), and soft palate (3). The best clinical response rate in post oral MCT was seen in the first 4 months (120 days). Objective response was observed in 67% of patients in the form of stable disease (56%) and partial response (11%). Disease progression was observed in 27% of patients. The median follow-up was 192 (6.4 months) days. The median estimated overall survival was 195 (6.5 months) days. The median estimated progression-free survival was 110 (3.6 months) days. Symptomatic relief with respect to pain was reported in about 75% of patients. Eighteen (21%) patients had Grade I–II mucosal reactions. Grade III–IV mucosal reactions were observed in five (6%) patients. Seventy-eight (93%) patients died at the end of the study at 1 year. Dose reduction was required in 15 (18%) patients. Conclusion: Oral MCT using celecoxib and methotrexate is an effective, economical, and well-tolerated regimen with good pain control and low toxicity profile in patients with locally advanced, recurrent and metastatic head-and-neck cancer.

Follicular Variant of Papillary Carcinoma Thyroid with Massive Angioinvasion of the Internal Jugular Vein: Our Approach

Follicular variant of papillary carcinoma thyroid is an aggressive variant of papillary carcinoma thyroid. It is more commonly associated with extrathyroidal extension and regional lymphadenopathy. It can rarely be associated with microscopic vascular invasion but tumor thrombus into great veins is a rare phenomenon. We present a case of 60-year-old male with follicular variant of papillary carcinoma thyroid with tumor thrombosis in superior thyroid vein and internal jugular vein (IJV). We report a case of a 60-year-old male who presented with a large swelling in the lower part of left side of neck for 4 months. Clinical examination revealed a hard swelling of 12x8 cm in left side of neck. Ultrasonography showed a solitary thyroid mass of the left lobe and a dilated left superior thyroid vein and ipsilateral IJV. Fine-needle aspiration cytology revealed follicular variant of PTC cells. Total thyroidectomy was done. A tumor thrombus was discovered in the superior thyroid vein and left IJV was found to be dilated. The left IJV with superior thyroid vein was ligated and excised. The patient recovered well after the operation with no local or distant metastasis detected. Follicular variant of PTC commonly spreads to the lymph nodes. Vascular spread via direct intravascular extension through superior thyroid vein is extremely rare. On palpation cord like IJV is felt on the involved side. Neck ultrasound play important role in the diagnosis. Aggressive surgical treatment with IJV ligation above and below the tumor thrombus is recommended to minimize the risk of potentially fatal complications of the intraluminal masses. Intravascular tumor extension into IJV of neck in follicular variant of PTC is rare and can be associated with serious consequences. Total thyroidectomy with thrombectomy with ligation of IJV must be done.

Efficacy of trospium for prevention of catheter-related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study / 대한마취과학회지

Background@#Catheter-related bladder discomfort (CRBD) is a frequent complaint after awakening from anesthesia in patients receiving perioperative bladder catheterization. Overactive bladder (OAB) and CRBD show similar symptoms; thus, drugs used for the management of OAB influence symptoms of CRBD. Trospium chloride has been found effective in managing resistant cases of OAB. We evaluated the efficacy of oral trospium on CRBD in the postoperative period. @*Methods@#Sixty-four male and female adult patients, with planned spinal surgery and requiring urinary bladder catheterization, were randomly divided into two groups of 32 each. Group T patients received 60 mg extended-release oral trospium (extended-release) 1 h before induction of anesthesia and Group C patients received a similar-looking placebo. The anesthetic technique was identical in both groups. The CRBD score was evaluated in the postoperative ward using a 4-point scale (1 = no discomfort, 2 = mild, 3 = moderate, 4 = severe). Readings were recorded on arrival (0 h), and 1 h, 2 h, and 6 h postoperatively. All patients received fentanyl for postoperative pain relief. @*Results@#The incidence of CRBD was significantly higher in group C than in group T at 0 h (66% vs 22%, P=0.001) and 1 h postoperatively (72% vs 28%, P=0.001). The incidence of moderate to severe CRBD was higher in group C at postoperative 2 h (82% vs 14%, P=0.004). There was no significant difference in postoperative fentanyl requirements. @*Conclusions@#Pretreatment with 60 mg ER trospium reduced the incidence and severity of CRBD in the early postoperative period.

Role of serum procalcitonin as a marker for diagnosing neonatal sepsis

Background: Neonatal sepsis is a continuing problem causing significant burden on health care, especially in developing world. As blood culture has low sensitivity in diagnosis of neonatal sepsis, strong clinical suspicion along with combination of different laboratory tests is required. The data available for extensively studied acute phase reactant, procalcitonin (PCT) remains controversial. This study was done to assess role of PCT alone and in combination with different tests for diagnosing neonatal sepsis.Methods: Blood samples of 275 neonates (>35 weeks of gestation) admitted to NICU, with suspicion of neonatal sepsis were collected for bacterial culture, serum procalcitonin level and sepsis screen (CRP, mESR, I/T ratio, Total Leucocyte Count, Absolute Neutrophil Count).Results: Blood culture was positive in 30.5% of enrolled neonates. At a cut-off value of 0.5 ng/ml the sensitivity, specificity, PPV, NPV of serum PCT in neonatal sepsis cases was 73.8%, 47.1%, 48%, 80.4% respectively. Serum PCT was found raised in 60 (48.8%) clinically suspected cases of neonatal sepsis where sepsis screen and blood culture both were negative, also it was not raised in 17 (32.7%) of clinically suspected cases of septicemia where both blood culture and sepsis screen were positive. Amongst other individual tests, CRP was found to have best sensitivity (79.7%) and NPV (85%) followed by PCT (73.8% and 80.4%) while best specificity was found for I/T ratio (93.7%) followed by mESR (89%) for diagnosis of neonatal sepsis with positive blood culture. Best NPV was seen for combination of PCT+CRP+I/T ratio (95.6%) for the suspected cases of neonatal sepsis.Conclusions: Thus, we conclude that serum PCT can play a useful role when combined with other test markers but may not find its way as a sole diagnostic marker for diagnosing neonatal sepsis in term/near term babies.

Drug utilization pattern of psychotropic medicines in tertiary care centre of Bastar Region, Chhattisgarh, India

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.

Evaluation of nephroprotective activity of Tinospora cordifolia against gentamicin induced nephrotoxicity in albino rats: an experimental study

Background: Gentamicin induced nephrotoxicity is a major contributor to Acute Kidney Injury (AKI) resulting from free radicals induced oxidative stress. Tinospora cordifolia is an Indian medicinal plant, widely used because of its antioxidant activity. Due to limited scientific literature exploring its nephroprotective potential, the present study was designed to investigate the nephroprotective effect of aqueous extract of Tinospora cordifolia against gentamicin induced nephrotoxicity in albino rats.Methods: The study was commenced following approval from Institutional Animal Ethical Committee of L.L.R.M. Medical College, Meerut (UP). Twenty four rats were randomised into four groups of six animals each. Total duration of study was 21 days. Group I received normal saline p.o., group II received normal saline along with gentamicin on last 5 days, group III and IV received Tinospora cordifolia in graded doses p.o. along with gentamicin on last 5 days. Injection gentamicin (40mg/kg) i.p. was given once daily for last 5 days to induce nephrotoxicity in rats of groups II, III and IV. The rats were sacrificed under anaesthesia, blood samples analysed for blood urea nitrogen (BUN) and serum creatinine levels and histopathological changes were studied. Statistical analysis was done using ANOVA followed by post hoc test.Results: Tinospora cordifolia pre-treated groups exhibited significant (p<0.001) limitation in rise in levels of BUN and serum creatinine in a dose dependent manner. Histolopathological observations further corroborated the biochemical findings.Conclusions: The present study concluded that aqueous extract of Tinospora cordifolia possesses nephroprotective potential against gentamicin induced nephrotoxicity.

Comparative efficacy of intravenous premedication of clonidine versus nalbuphine on intraoperative hemodynamic profile of patients during surgery under general anesthesia: a randomized study

Background: Airway manipulation and surgical stimulation lead to variable changes in hemodynamic profile due to increase in plasma catecholamine levels, but these changes can be attenuated by appropriate premedication. The present study was designed to compare the clinical efficacy of intravenous premedication of clonidine with nalbuphine on intraoperative hemodynamic profile of patients during surgery under general anaesthesia.Methods: Sixty adult consenting patients of ASA physical status I and II of either gender were randomized into two groups of 30 patients each, to receive either intravenous clonidine (2 μg/kg) or nalbuphine (0.2 mg/kg), 10 min before induction with propofol. Direct laryngoscopy and intubation were facilitated with vecuronium bromide. Changes in heart rate, blood pressure and electrocardiogram were recorded at specific time intervals and were noted as primary variable. Any adverse effects and complications were recorded as secondary outcomes.Results: After laryngoscopy and intubation, the increase in mean heart rate and mean blood pressure occurred immediately in patients of both groups, but persisted up to 6 to 10 min in patients of clonidine group, thereafter the changes returned back to baseline values, while in patients of nalbuphine group, this increase persisted up to 8 to 10 min. The differences in hemodynamic changes between the groups were statistically significant throughout the surgery and post extubation.Conclusions: Intravenous clonidine was more effective than nalbuphine to attenuate the hemodynamics changes during stressful period of laryngoscopy, intubation and surgery.