A Clinical Correlation of EEG Changes in Relation to Ischaemic Stroke on its Prognosis as per Location

Background : Stroke is a common, potentially devastating disease with potential high morbidity and mortality. EEG (Electro-encephalogram), functional representation of electrical activity of brain, changes are closely tied to CBF (Cerebral Blood Flow). Thus EEG is useful to establish the location of Ischaemic CVA (Cerebro-vascular accident). It can also prognosticate Ischaemic stroke. Aims & Objectives : (1) To assess the grade and severity of clinical manifestations in acute ischaemic stroke patients by clinical scoring following admission. (2) To obtain EEG findings of ischaemic stroke patients following admission and after 1 month. (3) To assess the morbidity of ischaemic stroke patients by Modified Rankin Scale after 1 month. (4) To correlate EEG changes according to the clinical outcome and according to the site of involvement of ischaemic stroke. Materials and Methods : 90 Patients were selected during the study period as per the inclusion and exclusion criteria. Clinical scoring was done by NIHSS (National Institute of Health Scoring System). CT (Computed Tomography) scan of brain and MRI (Magnetic Resonance Imaging) Brain with DWI (Diffusion Weighted Image) extension was done. EEG findings on admission of morbidity was done by Modified Rankin Score on follow up after 1 month was noted. EEG findings after 1 month was noted on follow up. Assessment Clinical correlation was compared with EEG changes. All the data were collected and analysed by statistical software SPSS version 20. Results : The mean MRS (Modified Rankin Score) after 1 month for abnormal EEG on admission was 4.50 in comparison to score of 3.36 in case of normal EEG. The p value of this association was 0.003 and was considered significant. Conclusions : Normal EEG and focal slowing of EEG was mostly noted in MCA (Middle Cerebral Artery) and PCA (Posterior Cerebral Artery) infarcts involving the cortical region. Those with normal EEG findings had good clinical outcome in comparison to those with abnormal findings in EEG

An Uncommon Presentation of a Common Etiology : Tubercular Cerebral Abscess in Pulmonary TB

A patient, recently diagnosed with Pulmonary Tuberculosis and on ATT for the last 1 month, was initially admitted in a primary care setup with severe headache and altered consciousness for 5 days and then referred to our institute for further management. Extensive investigations and imaging led to the conclusion that the patient had a massive Tubercular Brain Abscess (TBA) in the background of Pulmonary TB

Fundus findings in patients admitted with post COVID-19 sepsis in an intensive care unit

Purpose: COVID?19 infection is being increasingly identified as a risk factor for the development of ocular infections, especially endogenous endophthalmitis. Current studies primarily report cases among survivors, and the overall prevalence, especially amongst patients admitted with active sepsis is unknown. We report on the fundus and systemic findings of inpatients who were being treated for post?COVID?19 systemic secondary infections in a tertiary intensive care unit. Methods: Retrospective observational study based on chart review. Results: A total of 24 patients were identified. These included 21 (87.5%) males and 3 (12.5%) females with ages ranging from 33 to 72 years (mean 54.1 years). Pre?existing risk factors included type 2 diabetes mellitus, systemic hypertension, chronic kidney disease, multiple myeloma, and patients on long?term corticosteroid/immunosuppressive treatment. Nine patients (37.5%) died and 15 (62.5%) survived. Of a total of 48 eyes, observed fundus lesions included endogenous endophthalmitis (4 eyes of 2 patients, 8.3%), preretinal hemorrhages (4 eyes of 2 patients, 8.3%), optic disc pallor (2 eyes of 1 patient, 4.1%), moderate non?proliferative diabetic retinopathy (4 eyes of 2 patients, 8.3%), Roth spots (2 eyes of 1 patient, 4.1%), and 2 eyes of 1 patient (4.1%) with evidence of previous pan?retinal photocoagulation. Conclusion: Two patients had evidence of endogenous endophthalmitis. These findings suggest that the actual incidence of ocular lesions, especially infections is higher than that reported. Fundus examination should form a part of the management protocol for patients being treated for post?COVID?19 systemic infections

Evaluation of Plasma Fibrinogen Levels and Its Association with Microalbuminuria and Glycemic Control in Type 2 Diabetes Mellitus

Increased level of Fibrinogen is supposed to be a risk factor for Macrovascular disease. Insulin acutely increases Fibrinogen production in an individual with Type 2 Diabetes. There is a correlation between fibrinogen level and duration of Diabetes. Aim : To evaluate the levels of Plasma Fibrinogen and its association with Microalbuminuria and glycemic control in patients of Type 2 Diabetes Mellitus (T2DM). Materials and Methods : A hospital-based Cross-Sectional Study was conducted at the Department of Medicine, Bharati Hospital and Research Centre. The study aimed to evaluate the levels of plasma fibrinogen and its association with microalbuminuria and glycemic control in patients with T2DM. A total of 100 subjects (males and females) presenting with Diabetes Mellitus to our hospital were included in the study after informed consent. A detailed clinical history and relevant laboratory investigations were done. Statistical Analysis : The quantitative data was represented as their Mean盨D. Categorical and nominal data were expressed in percentage. The t-test was used for analysing quantitative data, or else non-parametric data were analysed by Mann Whitney test. All analysis was carried out by using SPSS software version 21. Results : Mean Fibrinogen level in study cases was 507.8 mg/dl with 26% had Fibrinogen levels of more than 500 mg/dl. Micro and Macro-albuminuria were seen in 25% and 9% cases. Mean Fibrinogen level was significantly more in cases with a duration of Diabetes 5 years, poor glycemic control and Microalbuminuria. Conclusion : Microalbuminuric Diabetic patients and poor Glycemic control patients showed higher fibrinogen levels. It can be concluded that Hyperfibrinogenaemia may precede the onset of Clinical Vascular Complications

Some Mites Occurring On Edible And Wild Mushrooms From Three Districts Of West Bengal With Their Economic Importance

The present paper reports occurrence of 15 species of mites under 10 families and 12 genera collected from edible and wild mushrooms from three districts of West Bengal during, September 2021 to April 2022. Among the mites, there were 9 predatory and 3 each of damage causing and of uncertain association. All the species have been listed giving collection data and remarks pertaining to their importance as damage causing, predatory, or of uncertain association. The mites like Tyrophagus putrescentiae, Fuscuropoda marginata and Leiodinychus krameri were abundantly encountered and were regarded as pest species. Similarly, the mites like Parasitus consanguineous and Asca biswasi were observed to be predator in nature

Rivaroxaban, a New Molecule with Potential to Balance Bleeding Risk and Ischemic Events in Patients with Chronic Coronary Syndrome

Globally, the prevalence of chronic coronary syndrome (CCS) increases with age. In India, there is a rapidly growing burden of coronary artery disease (CAD), which has become the leading cause of morbidity and mortality. Despite recommended medical therapy, patients with CCS are still at risk of ischemic events. Currently, dual antiplatelet therapy (DAPT) is recommended in the form of aspirin and a P2Y12 inhibitor or low dose rivaroxaban in patients with stable CAD and/or peripheral artery disease (PAD). A low dose of rivaroxaban in combination with aspirin is a promising approach; however, for patients who might benefit the most, it still remains a challenge. Clinical trial data on this new drug was certainly very encouraging, with evidence from the COMPASS trial and prespecified subgroups of COMPASS trials suggesting that the addition of rivaroxaban to aspirin was associated with a significantly lower risk of ischemic events, mortality, and tolerable bleeding profile in patients with CCS and high-risk factors. This combination is cost-effective and generally well tolerated in patients with CAD and/or PAD, as well as patients with CCS and multimorbidity or high-risk populations.

Evaluation and comparison of silorane resin composite to glass ionomer in occluso-proximal restorations of primary molars A randomized controlled trial

Objective: In general, proximal restorations of primary molars fracture, so it is vital to study the new materials that could solve this problem. Hence, the present trial assessed the success of occluso-proximal atraumatic restorative treatment (ART) restorations using silorane and glass ionomer cement (GIC) in carious primary molars for a period of 2 years. Materials and Methods: One hundred and ninety-two children between the age group of 4 and 9 years were randomly allocated to GIC or silorane. In the clinical set up, they were treated by a pediatric dentist, and their restorations were evaluated at 3, 6, 12, 18, and 24 months. The primary outcome was the survival of restoration, which was analyzed using the Kaplan–Meier and superior Cox regression models. As a sensitivity analysis, intention-to-treat (ITT) was executed. Sex, age, molar, jaw, cavity volume, and caries incidence were the independent variables. Results: The restoration survival after 24 months for GIC and silorane was 82.75% and 88.88%, respectively, whereas ITT analysis showed a success of 84.37% and 89.58% for GIC and silorane, respectively. Conclusion: With regard to longevity, there was no statistically significant difference between silorane and GIC in primary molar occlusoproximal ART restorations.

Intracranial Calcification in a Case of Seizure Disorder

A patient with repeated episodes of Seizures and elevated Blood Pressure for 2 days, was admitted in a primary care set up initially, followed by admission to our Institute where he was thoroughly worked up to find the possible etiology behind the presentation. Extensive investigations and imaging led to the conclusion that the patient had Idiopathic Intracranial Calcification after the possible secondary causes of Intracranial Calcification were ruled out

Surgical Outcomes of Unilateral Marcus Gunn Jaw Winking Ptosis Correction: A Novel Whitnall’s Ligament Approach

Purpose@#To evaluate the surgical, functional, and cosmetic outcome in moderate to severe ptosis with Marcus Gunn jaw winking phenomenon and recurrence of disease after ptosis correction. This procedure has been emphasized on a child. @*Methods@#This was a prospective, non-comparative, interventional study conducted over 4 years on 30 people. The ages range from 7 to 40 years. The eyelid was approached from behind to identify the Whitnall’s ligament. Levator palpebrae superioris was first disinserted then dissected up to the superior border of the tarsal plate followed by 20 to 25 mm by resection which causes disabling of the levator palpebrae superioris action. Subsequently, “tarso frontalis sling with silicon rod” for ptosis correction. Compared with the preoperative and postoperative photograph. @*Results@#Margin reflex distance 1 values are in the affected eye preoperative 1.8 ± 0.87 mm to postoperative 3.96 ± 0.41 mm. Preoperative palpebral fissure height are means 5.05 ± 0.62 mm to postoperative palpebral fissure height means 9.3 ± 0.71 mm. Ptosis significantly improved which is statistically significant (p < 0.05). Lid excursion or Flickering’s in affected eyes preoperative means 6.1 ± 3.47 mm to postoperative after 1 year means are 0.43 ± 0.81 mm. Follow-up period is 1 year. @*Conclusions@#Unilateral posterior approach (Whitnall’s ligament approach) is found better in surgical, functional, and cosmetic outcomes in the correction of Marcus Gunn jaw winking syndrome, especially in children. The risk of bilateral extensive surgery is avoided. After the surgery, the primary gaze face photo identity was well-accepted in official government documents. This study is stressed on bilateral lid height similarity in primary gaze unlike the traditional method of downgaze similarities. The patients were highly satisfied both physically and mentally.

Study of thyroid hormones in pregnancy

Background: Thyroid disorder is often overlooked in pregnant women this is because of nonspecific symptoms and hyper metabolic state of normal pregnancy. To evaluate the thyroid function in pregnant women in all the three trimesters and to study their impact on pregnancy outcome.Methods: A prospective study in 200 randomly selected antenatal cases was carried out during a period of two years in a tertiary care medical college in Western Maharashtra. A detailed general and systemic examination was carried out and Thyroid stimulating hormone (TSH) was done in all cases. Any case with an abnormal TSH level was further tested for T3 T4 levels.Results: The mean TSH level was 1.6 µIU/l which was less than the standard cut off of 2.5 µIU/l. 61% had decreasing level of TSH with advanced gestation. An abnormal thyroid function was seen in 8.5% cases.Conclusions: Standardization of TSH, T3, T4 is still a concern as it varies significantly in different studies. Estimation of TSH with T3 T4 could not be correlated during pregnancy with advancing gestational age. The real impact of hypo/hyperthyroidism on fetal outcome could not be statistically established.

A Study to Evaluate the Efficacy of Acupuncture for Treating Allergic Rhinitis

Introduction: Allergic Rhinitis is a common inflammatorydisease of the nasal mucosa. It is a symptomatic disorderof the nose induced after allergen exposure due to an IgEmediated inflammation of membranes lining the nose. Usualtreatment of Allergic rhinitis includes allergen avoidance,effective symptomatic treatment, antihistamines or steroids,standardized immunotherapy, and patient health education.There are also recommended complementary and alternativemedicine (CAM) therapies including, Ayurvedic medicine,herbal medicines, Acupuncture, Homeopathy, and severalother modalities.Material and methods: This study was conducted on 80patients diagnosed positive for Allergic Rhinitis attending theOutdoor Patient Department (OPD) of Dr. D.N. Kotnis Health& Education Centre, Ludhiana, Punjab. The severity of thepatient’s problem was taken on Liker’s scale at their first visitand the last visit of the treatment. The acupuncture points werepunctured until the needling sensation/ Qi was achieved. Thepoints were connected with an electrical stimulator for 30-40 minutes followed by a moxibustion application with stickmoxa for 15-20 minutes. The collected data were subjected tomultinominal logistic regression using ROCR package of theR programming environment.Results: It is noted that, statistically after treatment, theresults for pre and post-treatment varied significantly withp=0.0039, df= 15. There was maximum improvement seen fornasal symptoms and insomnia treatment.Conclusion: Acupuncture provides an effective and safetreatment modality for allergic rhinitis. It provides a significantreduction in major symptoms of allergic rhinitis improving theQuality of life of the patient.

A rare case of colonic perforation presenting as Fournier’s gangrene

A 48-year-old obese gentleman with mild pain over abdomen for 10 days followed by pain and swelling in the right side of scrotum with skin discolouration for 2 days. Clinically necrotic patch with pus discharge was noted on the right side of scrotum. Extensive debridement over scrotum was done following which inflamed omentum and fecal contents were noticed from the inguinal canal. Patient underwent laparotomy and an ascending colonic perforation was found. A loop colostomy with partial omentectomy and inguinal hernia repair along with serial debridement of scrotal wound was done. Although uncommon, gastrointestinal perforations should be considered as a potential etiology in Fournier’s gangrene.

A Retrospective Study to Estimate the Prevalence of Anemia and Associated Factors among First Year MBBS Students of Maharaja Agrasen Medical College, Agroha, Hisar.

Introduction: Anemia is a most common public healthproblem affecting around 1.9 billion population of the world.It is a severe public health problem in India. Medical studentsare vulnerable to develop anemia due to irregular eatinghabits due to hectic study schedule. Anemia among this agegroup has significant health consequences resulting in poorcognition, decreased attention span and memory affectingthe performance, depressed immunity, repeated infections,increased fatigue, and shortness of breath, dizziness, blurredvision, low endurance and irregular menstruation.Material and Methods: This study is conducted among 100students of both gender taking admission in MBBS first yearat MAMC, Agroha. Hemoglobin values and other relevantdetails of the students were taken from academic sectionsubmitted at time of admission. World Health Organizationcriteria were taken to determine the severity of anemia.Modified B.G. Prasad scale was used to assess the socioeconomic status of the family. Data was first entered into MSexcel sheet and then was exported to SPSS version 20.0 forappropriate analysis.Results: Prevalence of anemia came out to be 54% amongstudy subjects. Difference between the mean levels ofhemoglobin across the genders came out be statisticallysignificant (P=<0.001).Conclusion: Prevalence of anemia is high among the studysubjects with more prevalence among females study subjects.There is a need to accelerate efforts for achieving control ofanemia by strengthening multi-sectoral partnership involvinggovernment departments, academic institutions, bilateralagencies and food industry.

Interventional Study to Evaluate Efficacy of Acupuncture for Treating Sciatica Pain

Introduction: Low back pain has a profound impact bothdirectly and indirectly on individuals. It is estimated that 60%to 80% of any population will experience low back pain atsome point in their lives. There are number of causes for lowback pain and Sciatica is one of them. Study aimed to assessthe efficacy of Acupuncture for the management of Sciaticapain.Material and Methods: This study was conducted among 200patients attending the Outdoor Patient department at Dr D.N.Kotnis Health and Education Center. With each subject a priorinformed and written consent was obtained. A predesigned andpretested proforma was used to collect the socio demographicprofile. Severity of Pain was measured with the help of LikertScale whereas the reading on Likert scale was taken at thetime of first visit and last visit of patients for comparison ofpain. Data was first entered into MS excel sheet and then wasexported to SPSS version 20.0 for appropriate analysis.Results: Wilcoxon signed rank test was applied to determinethe efficacy of the treatment on reducing the pain, further itwas observed that the effect of the treatment was statisticallysignificant (p<0.001)Conclusion: Acupuncture provides effective relief fromSciatica pain. However initiation of treatment at young ageprovides quick response and healing by reducing suffering ofsciatica pain.

Observational, Concurrent Study to Assess Safety and Efficacy of Glycopyrronium and Arformoterol Home Nebulization in High-risk, Symptomatic Acute Exacerbation of Chronic Obstructive Pulmonary Disease Cases: SYMPTOM Study

Background: Chronic obstructive pulmonary disease (COPD) is one of the most important reasons for hospitalizationworldwide with high 30-day readmission rates. Although the prognostic significance of early readmission is not fully understood,they are often associated with poor outcomes including high mortality rates of 4%–19% at 30 and 365 days, respectively.Similarly, in acute exacerbations of COPD (AECOPD) cases receiving emergency department care, current status on lungfunction and cardiovascular comorbidities are considered as best predictors for both 30- and 90-day COPD readmission rates.Dual bronchodilator strategy with long-acting muscarinic antagonist (LAMA)/long-acting beta-agonists (LABA) is thereforerecommended by GOLD (2019) in the postdischarge phase following an acute exacerbation.Aim: To further assess the clinical impact of dual bronchodilators including glycopyrronium and arformoterol as home nebulizationin the post-discharge phase of AECOPD, the current postapproval, observational study was conducted.Materials and Methods: An observational, concurrent, and non-inferiority study with glycopyrronium and arformoterol homenebulizing solutions on patients with moderate and severe COPD was conducted at two centers in India. An estimated samplesize of 40 patients involving moderate and severe COPD cases was factored for per-protocol analyses with P < 0.05 consideredas statistically significant. A concurrent study analysis for the follow-up visit was conducted as per the principles of InternationalConference of Harmonization for Good clinical practice and Declaration of Helsinki while ensuring confidentiality during accessof patient support registration sheets.Results: Per protocol analyses for consecutive 46 cases from two centers receiving Nebulized glycopyrronium (25 mcg) andarformoterol (15 mcg), as separate formulations are given as admixed solution with follow-up visit for at least 4 weeks wascarried out. Baseline demographics for the overall group showed exacerbation history (46, 100%), hospitalization for AECOPD(21, 45.6%); ED visit (25, 54.3%), forced expiratory volume in one second (FEV1) 1.2 ± 0.6 L/min; FEV1/FVC64.8% ± 10.6;reversibility 8.4% ± 11.8; CAT 34.6 ± 2.3; and vibrating mesh nebulizer (46, 100%). The mean predose FEV1 (∆) at the end of 4weeks for overall, moderate and severe COPD cases were observed as of 9.6±3.1%, 11.8% ± 3.1, and 8.4% ± 1.6, respectively(P < 0.0001). Similarly, the mean CAT(∆) score at the end of 4 weeks was observed as of 18.1 ± 0.69, 20.6 ± 0.69, and 18.26 ±0.6 for overall, moderate and severe COPD cases, respectively (P < 0.0001). The intergroup differences for rescue medicationuse for a lone case with severe COPD (1, 2.04%) complied with the suggested non-inferiority margin between the groups.There were no other treatment-emergent adverse events or serious adverse events that warranted treatment modification orwithdrawals in both groups.

Prevalence of beta thalassemia mutations in population of Gujarat using amplification-refractory mutation system–polymerase chain reaction

Background: Beta thalassemia is the most common genetic disorder in India. Its trait, coinheritance and mutations vary from mild to severe condition, resulting in thalassemia minor (heterozygous), intermediate and major depending upon many factors. The objective of this study was to find out the prevalence rate and the carrier of beta thalassemia in population of Gujarat using molecular genetic analysis of beta thalassemia patients by targeted mutation assay (ARMS-PCR).Methods: A total 105 samples for beta thalassemia were analysed for IVS 1-5 (G→C) and CD 15 (G→A) mutations. These two common mutations of thalassemia in Gujarat were carried out using amplification refractory mutation system–polymerase chain reaction (ARMS-PCR) and gel electrophoresis method.Results: A total 105 samples referred to us for molecular genetic analysis. The occurrence of positive mutations of IVS 1-5 (G→C) and CD 15 (G→A) were found in 48 and 15 samples respectively. The rest were negatives.Conclusions: Present study concludes that the prevalence rate of Beta thalassemia was widespread among the Gujarat population. The identification of IVS 1-5 (G→C) and CD 15 (G→A) mutations was carried out. The analysis revealed that, mutational patterns of IVS 1-5 (G→C) was the most frequent among other mutations in Gujarat region.

Influence of Smokeless Tobacco on Periodontal Health Status in Local Population of North India: A Cross-Sectional Study

Introduction: In addition to smoking, smokeless tobacco hasalso evidently shown its effect on various oral tissues.Smokeless tobacco products have been in existence forthousands of years among populations in South America andSoutheast Asia in varied forms.Methodology: This cross-sectional study investigated theeffect of commonly used smokeless tobacco on periodontalhealth in local population of nearby villages of Air Force StationBakshi Ka Talab, U.P., India, for which 2045 individuals[males=1455 (71%), females=590 (28.9%)] were evaluated.Results: Maximum incidence of smokeless tobaccoconsumption was observed in the age group 21–30 years(39.4%), whereas minimum consumption was observed in theage group 10–20 years (7.5%). The peak smokeless tobaccoconsumption was observed between the ages 21 and 40 years.Recording of oral hygiene measures included in this studyshowed majority of subjects (n=1961) used tooth brushing asthe oral hygiene measure, while some used datoon (n=30;1.5%) for cleaning their teeth and others used their finger(n=54; 2.6%) with or without tooth powder.Conclusion: This study conclude that, PPD were significantlyhigher statistically amongst longer duration (>5 years)smokeless tobacco users as compared to non-tobacco users.

Special Histological Types of Breast Carcinoma- A Retrospective Study

Background: Breast cancer is a heterogeneous disease that encompasses several distinct entities with remarkably different characteristics . Histological type is the most important aspect of breast carcinoma characteristics. Histological type is associated with differences in epidemiology , diagnostic issues , clinical course & prognosis . Histological special types account for about 25% of breast cancer. Aim-The aim of this study is to identify the incidence and morphology of special types of breast cancers prevalent in our locality along with assessment of IHC status(ER,PR,Her2/neu)for better understanding of rare malignant tumors. Methods: This was aretrospective analysis of all special subtypes of breast cancers over a period of six years (July 2011-June 2017) in the department of Pathology ,VSSIMSAR,Burla,Odisha.Clinicopathological parameters and IHC status were reviewed in all cases. Results: All patients were females with median age of 51 years and undergone modified radical mastectomy. Out of total 448 cases of all breast carcinomas22 cases are of special histologic types.Medullary carcinoma was the most common type ( 7cases )( 13.8%) followed by metaplastic carcinoma(5cases)(22.7%), lobular carcinoma 3(cases )(13.6%),apocrine carcinoma 3(13.6%)cases, papillary carcinoma2(9%)cases, one(4.5%)case each of mucinous carcinoma and sebaceous carcinoma. Conclusion: The identification of the special types has a significant utility in luminal breast cancers and should be considered in therapeutic algorithm.

Multifocal Retiform Hemangioendothelioma Of Bone Masquerading As Skeletal Metastasis

Hemangioendothelioma (HE) is a rare primary bone tumor of vascular origin constituting 0.5–1% of primary malignant bone tumors. Here, we report the clinical and histopathological features of a 38-year-old male who presented with multifocal lesions involving the left scapula, left proximal humerus, and the left ulnar olecranon process which was diagnosed as metastatic lesion radiologically and clinically. The final diagnosis of retiform HE was made on the basis of histopathology.