Health-related quality of life among people living with HIV/AIDS on highly active antiretroviral treatment: A questionnaire-based study

Introduction: The knowledge of the effect of sociodemographic and disease-related factors on health-related quality of life (HRQoL) among people living with HIV/AIDS (PLWHA) is important for planning comprehensive health-care services for them. Material and Methods: Two hundred PLWHA on antiretroviral therapy (ART) volunteered to complete a self-reported World Health Organization’s Quality of Life?HIV brief questionnaire (WHOQoL-HIV-BREF) that examines six domains each with four items (physical, psychological, level of independence, social, environmental, and spiritual) with 25 facets and additional 5 facets specific to PLWHA (symptoms of HIV, social inclusion, forgiveness, worries about the future, and death and dying). Results: Only 135 questionnaires from 73 (53.3%) men and 63 (46.7%) women (male: female – 1.14:1) aged 20–82 years(mean ± standard deviation: 42.9 ± 10.5 years) were found complete. Eighty-five (63%) individuals were aged 41–60 years, 78 (57.8%) individuals were matriculates, graduates, or postgraduates, 76 (56.3%) respondents were married, and 38 (28.1%) were widows/widowers. Staying-alone workers comprised 43 (31.8%) individuals. Overall health and HRQoL were rated satisfactory (n = 85.2%) and good/very good (n = 74.8%) by a significantly greater number of individuals (P = 0.001). Pearson’s Chi-squared test showed no statistically significant (P > ?) associations between good HRQoL and variables such as age >40 years, gender, education, marital status, duration of disease, disclosure of serostatus to family, ART for >3 years, and CD4 >200 cells/mL. Conclusion: Regular ART can result in adequate control of immunosuppression and no comorbidities in a majority of PLWHA, family and social acceptance, and financial security can result in overall good HRQoL in all six domains within the WHOQoL-HIV-BREF. The study is limited by its cross-sectional study design and small sample size.

A Case Control Study on Risk Factors and Drug Prescription Patterns in Glaucoma at a Tertiary Eye Care Center in a City of Western India

Introduction: Glaucoma is an idiopathic, progressive optic disc neuropathy complicating into irreversible blindness if untreated. Early diagnosis by screening cases from high-risk populations has a pivotal role in managing this major public health problem with high treatment expenditures. Objectives: To identify the various ocular and non ocular risk factors of glaucoma and to identify the drug prescription pattern among glaucoma patients. Method: This was an observational, case-control study including 165 adult Glaucoma patients on treatment as cases and 165 age and sex-matched healthy individuals as controls, all of which were randomly selected from the patients visiting a tertiary eye care center. Various risk factors, drug prescription pattern and symptoms of the patients were recorded and analyzed. Results: A total of 165 adult Glaucoma patients and age and gender matched 165 controls were enrolled. Majority of the patients (41.21%) complained of blurring of vision at the time of study. The Odds ratios for Family history, Hypertension, Diabetes Mellitus, Migraine, Sleep apnea and Smoking showed strong association as risk factors for Glaucoma and the differences between the two groups were statistically significant (p value < 0.05). The mean number of drugs per prescription ± SD was 1.88 ± 0.79. Fixed drug formulations were prescribed in 42.4% patients. All the drugs were prescribed by their brand names and majority of them were in the form of eye drops. Conclusion: Primary Open Angle Glaucoma (POAG) was the most common subtype in the study. Age, Family history, Myopia, Hypertension, Diabetes Mellitus, Sleep Apnea, Migraine, Corticosteroid usage and Smoking emerged as putative risk factors. In consistence with present guidelines, Prostaglandin analogs were the most prescribed antiglaucoma drugs. The considerable proportion of asymptomatic cases (23%) suggests the need for periodic eye examinations to detect glaucomatous changes at an early stage.

In vitro and in vivo anticancer potential and molecular targets of the new colchicine analog IIIM-067 / 中西医结合学报

OBJECTIVE@#The current study evaluated various new colchicine analogs for their anticancer activity and to study the primary mechanism of apoptosis and in vivo antitumor activity of the analogs with selective anticancer properties and minimal toxicity to normal cells.@*METHODS@#Sulforhodamine B (SRB) assay was used to screen various colchicine analogs for their in vitro cytotoxicity. The effect of N-[(7S)-1,2,3-trimethoxy-9-oxo-10-(pyrrolidine-1-yl)5,6,7,9-tetrahydrobenzo[a] heptalene-7-yl] acetamide (IIIM-067) on clonogenicity, apoptotic induction, and invasiveness of A549 cells was determined using a clonogenic assay, scratch assay, and staining with 4',6-diamidino-2-phenylindole (DAPI) and annexin V/propidium iodide. Mitochondrial membrane potential (MMP) and reactive oxygen species (ROS) levels were observed using fluorescence microscopy. Western blot analysis was used to quantify expression of proteins involved in apoptosis, cell cycle, and phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) signaling. Pharmacokinetic and in vivo efficacy studies against Ehrlich ascites carcinoma (EAC) and Ehrlich solid tumor models were conducted using Swiss albino mice.@*RESULTS@#IIIM-067 showed potent cytotoxicity and better selectivity than all other colchicine analogs screened in this study. The selective activity of IIIM-067 toward A549 cells was higher among other cancer cell lines, with a selectivity index (SI) value of 2.28. IIIM-067 demonstrated concentration- and time-dependent cytotoxicity against A549 cells with half-maximal inhibitory concentration values of 0.207, 0.150 and 0.106 μmol/L at 24, 48 and 72 h, respectively. It also had reduced toxicity to normal cells (SI > 1) than the parent compound colchicine (SI = 1). IIIM-067 reduced the clonogenic ability of A549 cells in a dose-dependent manner. IIIM-067 enhanced ROS production from 24.6% at 0.05 μmol/L to 82.1% at 0.4 μmol/L and substantially decreased the MMP (100% in control to 5.6% at 0.4 μmol/L). The annexin V-FITC assay demonstrated 78% apoptosis at 0.4 μmol/L. IIIM-067 significantly (P < 0.5) induced the expression of various intrinsic apoptotic pathway proteins, and it differentially regulated the PI3K/AKT/mTOR signaling pathway. Furthermore, IIIM-067 exhibited remarkable in vivo anticancer activity against the murine EAC model, with tumor growth inhibition (TGI) of 67.0% at a dose of 6 mg/kg (i.p.) and a reduced mortality compared to colchicine. IIIM-067 also effectively inhibited the tumor growth in the murine solid tumor model with TGI rates of 48.10%, 55.68% and 44.00% at doses of 5 mg/kg (i.p.), 6 mg/kg (i.p.) and 7 mg/kg (p.o.), respectively.@*CONCLUSION@#IIIM-067 exhibited significant anticancer activity with reduced toxicity both in vitro and in vivo and is a promising anticancer candidate. However, further studies are required in clinical settings to fully understand its potential.

A RARE CASE REPORT OF GLOMUS TUMOUR OVER MARGIN OF LOWER LID OF LEFT EYE

Introduction: Glomus tumours are rare, benign tumours of vascular origin, arising from the glomus body. Glomus tumours are neoplasms of mesenchyme derived from glomus bodies. Glomus tumours present as a purple or pink vascular lesion that can be confused with a vascular neoplasm such as hemangioma. In this case we are reporting a rare presentation of glomus tumour over lower lid. A 10 year old female child presented with lesion over left lower Case Report: lid since 3 months which was painless and progressive. On examination a 0.3x0.3 cm subcutaneous pink non encapsulated mass is seen over medial canthus of left eye. Mass was excised and subjected to histopathological examination which confirmed the diagnosis of glomus cell tumour(glomangioma). Postoperative period was uneventful with no recurrence for last 6months. Conclusion: All excised eyelid lesions should undergo detailed Histopathological evaluation and glomus tumour should be considered as one of the differential diagnosis in patients presenting with eyelid mass

Deciphering the enigma of astigmatism in cataract surgery

Background: With about 87% of patients with cataracts having astigmatism, management of astigmatism in cataract surgery not only yields an improved unaided visual acuity and image quality but also higher patient satisfaction. The video will give a step?wise guide to cataract surgeons to manage astigmatism with cataracts. Purpose: To hit the bull’s eye as far as target refraction is concerned, it is necessary to understand the benefits and limitations of currently available cutting?edgetechnology and formulae and apply them to the cataract surgery practice. The purpose of the video is to make sure that we have no surprises in our Toric intraocular lens (IOL) planning. Synopsis: After a brief introduction to available modalities for the treatment of astigmatism, a step?wise approach to diagnostics is discussed, which will include the role of corneal topography and aberrometers and their application to planning Toric IOLs. Appropriate planning, implementation, and execution in form of preoperative and intraoperative pearls of using Toric IOLs are shown in the video. This will be followed by troubleshooting and case?based discussions and future perspectives including the possible role of corneal biomechanics. Highlights: What this video adds new is the importance of topography, interpretation of Belin?Ambrosio display map and the equivalent keratometry reading (EKR) map, aberrometry, and higher order aberration (HOA) analysis and role of biomechanics in Toric IOL planning. Video also highlights the importance of posterior corneal astigmatism and accurate axis marking. With a case?based approach and relevant examples, we are trying to decipher the enigma of astigmatism by giving a step?wise approach for the same

Resistant invasive Candida auris reported in neutropenic patients treated successfully with three antifungals

Candida auris is a deadly fungal pathogen able to cause fatal symptoms in immunocompromised patients. It may be misidentified and difficult to clinically diagnose. The guidelines are to employ Echinocandin and Amphotericin B in the treatment, but the following study elucidates successful treatment of infection by a combination of three classes of antifungal drugs; never reported before. We present a patient with fulminant acute disseminated encephalomyelitis and neutropenia who developed invasive candidiasis despite appropriate antifungal therapy. We successfully treated ongoing candidemia with three antifungal drugs which lead to the resolution of fungemia after 18 days of treatment. Isolation, segregation, waste disposal, and deep cleaning technique were also followed as recommended by the Infectious Diseases Society of America guidelines. First report ofCandidemia in an immunocompromised patient was successfully treated with three classes of antifungal drugs, IV Micafungin, Amphotericin B, and Posaconazole for nearly 18 days.

AVIAN DIVERSITY (LOCAL AND MIGRATORY BIRDS) AND HABITAT USE OF NANDUR MADHYAMESHWAR BIRD SANCTUARY, NASHIK DISRICT, MAHARASHTRA (INDIA)

This study is mainly based on observation of bird community in Nandur Madhyameshwar area. Nandur Madhyameshwar has a very good biodiversity as well as a wide variety of plants and animals. It is surrounded by large humid terrain and a variety of ?owers and fruit trees, providing food, breeding and nesting support for avian animals. Birds have stable wings, beak, feathers and body temperature. The feathers below keep the birds warm. Contour wings help birds to ?y and attract mates. Birds need a high energy diet to get energy for ?ight. Light bodies and strong muscles help birds to ?y. The pushes the wings to hold the bird in the air. The birds hatch their eggs and keep them in nests. When the chicks come out, they are prehospital or altruistic. A total of 24 different bird species are observed including 14 residents migratory, 2 migratory and 8 residents. It turns out that the respective communities show signi?cant diversity.

Nationwide surveillance for S-Metoprololtreatment effect on blood pressure control against sympathetic overdrive in Indian patients with hypertension (PROTECT)

Background:Patients with hypertension in India been reported with high heart rate owing to sympathetic overdrive (SO). Beta-blockers provides several positive effects to reduce SO in patients with hypertension. The aim of present survey studywasto understand current real-world prevalence of SO in Indian patients with hypertension and usage of beta-blocker therapy in them.Methods:A cross sectional, observational, questionnaire-based survey conducted across India between June 2020 to October 2020. A specially designed validated questionnaire was shared with 157 registered health care practitioners (HCP),their anonymous inputs were captured and analysed in qualitative manner. Categorical data was summarized by number (n) and percentage (%). Results:Total 157 HCP participated and completed the survey. Around 53% of HCP observed that patients with average heart rate above 75 beats/min were associated with negative prognosis. Around 43% of HCP reported that raised heart rate is associated with advancedage and increased body mass index (BMI). Two-third of HCP reported that tachycardia is associated with stage-2 hypertension and marked by restlessness and anxiety which is suggestive of SO. Over 70% HCP agreed that the HR below 75 beats/min is associated with good prognosis. Around 89% HCP reported beta-blockers as the drug of choice in patients with augmented SO. S-Metoprololwas reported to bethemost preferred beta-blocker agent and was recommended by 76% HCP in patients with hypertension and coexisting SO.Conclusions:SO been reported prevalent conditionin Indian patients with hypertension which likely worsensthe prognosis in these patients. Beta-blockers reported to be the preferred choice of anti-hypertensive and S-Metoprololseem to be themost preferred agent amongst the available beta-blockers against SO in patients with hypertension in India.

Yonishaithilya (Perineal Laxity) - A Comprehensive Review

Yonishaithilya is a common gynecological problem of women of contemporary era which has very important impact on female’s sexual function. This must not be taken lightly as they can adversely affect the quality of woman’s life. As per Brihatrayi, Yonishaithilya represents as a symptom of Mahayoni Yonivyapada, Vatala Yonivyapada, Phalini Yonivyapada and Karnini Yonivyapada, not as a separate disease. Etiology, sign, symptoms and treatment of Yonishaithilya resembles with perineal laxity. Perineal laxity is the condition where there is loosening of supporting structure of female pelvis, thereby allowing the descent of one or more pelvic organ through the lax vaginal introitus. Data Source: Brihatrayees and Laghutrayees, also from all contemporary textbooks, Relevant journals and Websites; Review method: Literary review; Objective:. This review article summarizes details of Yonishaithilya, current scientific researches and elaborates the various therapeutic procedure and drug formulations suggested in Ayurveda for the treatment of Yonishaithilya. Scope and Conclusion: Ayurveda gives various Panchakarma and Sthanik chikitsa like local application of Pichu, Snehana Swedana which are economical, easy and nonsurgical; many single plants; herbal formulations used traditionally which gives an eminent result in Yonishaithilya. Untreated Yonishaithilya may produces complications like pelvic organ prolapse, urinary incontinence and may convert into 2nd or 3rd-degree prolapse where conservative treatment is not beneficial. In some cases, a patient has been advised for a hysterectomy but the patient is reluctant to undergo surgery. So, it is preferred to try Ayurvedic medicine which may be the step to avoid hysterectomy. So, it is necessary to treat it as early as possible.

A diagnostic dilemma in pediatric osteomyelitis: a case report

Infantile osteomyelitis is a rare disease that is infective in nature and may rapidly turn fatal, as the disease is often misdiagnosed due to its varied presenting signs. Early diagnosis may help in avoiding systemic involvement and permanent deformity. The disease presents with signs of orbital involvement, nasal congestion, and emesis, as well as other standard hallmarks of infection. Furthermore, the maxilla is a highly vascular and porous bone and the occurrence of osteomyelitis in an infant maxilla is highly uncommon. In addition, routine blood work is not suggestive of the presence of this disease. Thus, prompt diagnosis of this condition poses a challenge to surgeons due to the confusing array of symptoms combined with the rarity of the disease. One such case of osteomyelitis of the maxilla in a young child is presented. The dilemma encountered by the surgeon during the diagnosis and treatment of the disease is discussed.

In-Silico Analysis of Chromatin Modifiers and Profiling of Histone Deacetylases (HDAC’s) in Human Oral Cancer / 전남의대학술지

Histone modifications have been demonstrated to play a significant role in oral squamous cell carcinoma (OSCC) epigenetic regulation. An in-silico analysis of The Cancer Genome Atlas (TCGA) of various histone acetyl transferases (HATs) and histone deacetylases (HDACs) suggested that HATs do not differ between normal and tumor samples whereas HDAC2 and HDAC1 change maximally and marginally respectively between normal and tumor patients with no change being noted in HDAC6 expression. Hence, this investigation was carried out to validate the expression states of HDAC 1, 2 and 6 mRNAs in buccal mucosa and tongue SCC samples in an Indian cohort. Buccal mucosa and tongue squamous cell carcinoma tissues with intact histopathology were processed for RNA isolation followed by cDNA synthesis which was then subjected to q-PCR for HDACs. The average RNA yield of the tongue tissue sample was ∼2 μg/mg of tissue and the A260/280 ratios were between 2.03 and 2.06. The average RNA yield of buccal mucosa tissue sample was ∼1 μg/mg of tissue and the A260/280 ratio were between 2.00 and 2.08. We have demonstrated that HDAC2 was overexpressed in tongue and buccal mucosa samples. Over-expression of HDAC2 imply potential use of HDACi along with standard chemotherapeutic drug in oral cancer treatment.

In-Silico Analysis of Chromatin Modifiers and Profiling of Histone Deacetylases (HDAC’s) in Human Oral Cancer / 전남의대학술지

Histone modifications have been demonstrated to play a significant role in oral squamous cell carcinoma (OSCC) epigenetic regulation. An in-silico analysis of The Cancer Genome Atlas (TCGA) of various histone acetyl transferases (HATs) and histone deacetylases (HDACs) suggested that HATs do not differ between normal and tumor samples whereas HDAC2 and HDAC1 change maximally and marginally respectively between normal and tumor patients with no change being noted in HDAC6 expression. Hence, this investigation was carried out to validate the expression states of HDAC 1, 2 and 6 mRNAs in buccal mucosa and tongue SCC samples in an Indian cohort. Buccal mucosa and tongue squamous cell carcinoma tissues with intact histopathology were processed for RNA isolation followed by cDNA synthesis which was then subjected to q-PCR for HDACs. The average RNA yield of the tongue tissue sample was ∼2 μg/mg of tissue and the A260/280 ratios were between 2.03 and 2.06. The average RNA yield of buccal mucosa tissue sample was ∼1 μg/mg of tissue and the A260/280 ratio were between 2.00 and 2.08. We have demonstrated that HDAC2 was overexpressed in tongue and buccal mucosa samples. Over-expression of HDAC2 imply potential use of HDACi along with standard chemotherapeutic drug in oral cancer treatment.

Comparison of Levobupivacaine and Lidocaine for Post-Operative Analgesia Following Tympanoplasty

A pure s-enantiomer of bupivacaine known as levobupivacaine, is now considered a safer alternative for regional anaesthesia than a racemic solution, bupivacaine since it is as efficacious as bupivacaine, but with better pharmacokinetics. Levobupivacaine is clinically tolerated well in cases requiring regional anaesthesia with both bolus administration and post-operative infusion. There are very few incidence of Adverse Drug Reactions (ADR) if administration is monitored appropriately as most ADRs are due to mistakes causing systemic exposure of drug. Hypersensitivity reaction to drug or pharmacological effects of anaesthesia though rare can also cause ADRs.1 Lidocaine (Xylocaine), is available commonly in a 0.5 % or 1 % solution, though several more concentrations are available. It is the most commonly used infiltrative amide anaesthetic. Higher concentrations show no difference in pharmacodynamics but may increase the risk of toxicity.2 The duration of action may be increased by addition of epinephrine. It can be added in concentrations of 1:100,000 or 1:200,000. This is seen to increase the maximum dose of drug and also reduces blood loss.3 Recent studies have found this combination to be safe to use in nose, ears, fingers and toes. METHODSA randomized comparative study was carried out in a tertiary care teaching hospital, Karad. A total of 112 cases was enrolled in the study who were having chronic suppurative otitis media and who require surgical management by tympanoplasty. Cases with a previous history of ear surgery were excluded. The enrolled cases were classified into group I and group II alternatively and the group I cases were given levobupivacaine 0.5 % and group II were given lidocaine 2 %. Infiltration with local anaesthetic was given in post auricular region. Perioperative analgesics were not given. Post-operative pain was measured by using VAS score and comparison of both groups was done by the Mann Whitney U test. RESULTSLevobupivacaine (8.6 mL) and lidocaine (9.2 mL) used during tympanoplasty in cases were stable throughout the procedure and no post-operative complications were noticed. The mean time of analgesic requirement was 186.43 ± 91.04 minutes and 329.54 ± 135.82 minutes respectively in levobupivacaine group and lidocaine group. The mean quantity of analgesics used was 1.95 ± 1.01 tablets and 3.34 ± 1.10 tablets in the levobupivacaine and lidocaine groups respectively.

Steroid and Antioxidant in the Treatment of Oral Sub Mucous Fibrosis - A Comparative Study

Oral Sub Mucous Fibrosis (OSMF) is a common condition found in India due to unique habit of chewing areca nut mixed with pan masala, gutkha, tobacco and spicy food etc. Once started and if neglected it can get transformed into malignancy. The disease once stared can only be controlled with life style changes. We wanted to study the effectiveness of intralesional injection of triamcinolone acetonide, oral llycopene alone and a combination of both in the treatment of oral submucous fibrosis. METHODSThis is a randomised comparative study. All cases with history of chewing of areca nut, pan masala, gutkha, tobacco and associated intolerance to spicy food, restricted mouth opening (grade III) and of age ranging between 15 - 70 years irrespective of gender were included in this study. Patients with previous history of treatment for oral sub mucus fibrosis, disorders of temporomandibular joint and pre-malignant conditions such as leukoplakia, drug allergy were excluded. A total of 150 enrolled cases were randomized into group I, II and III and treated with 1 mL of intralesional injection of triamcinolone acetonide weekly, lycopene capsule twice daily and both in combination respectively for a period of two months. Group II and III cases received oral lycopene throughout the study period, whereas group I and III cases received weekly injection of triamcinolone acetonide till mouth opening of 36 mm or more was achieved. All cases were followed up every two weeks for entire study period of two months, final follow up after two months and oral cavity was assessed for mucosal ulcerations, palpable fibrous bands, mouth opening in millimetres, and tolerance to spicy foods. RESULTSThe number of males and females amongst all groups was 71 and 79 respectively. The most common age group was 51 - 70 years. The mouth opening in 150 cases (grade III) of all groups showed significant improvement (p < 0.001) to grades I and II, of which the group III had maximum mouth opening of 20.22 ± 0.07mm. Amongst all groups in 143 cases, painful mucosal ulcerations disappeared in 136 (95.10 %) and majority (49) were from group II. Similarly, amongst all groups in 142 cases the symptom of burning sensation disappeared in 130 (91.5 %), and majority (49) were from group III. Also, amongst all groups in 150, palpable fibrous bands in oral cavity disappeared significantly in 138 (92 %) (p < 0.15), and the majority (49) were from group III, in remaining 12 it became supple. CONCLUSIONSGroup III agent lycopene in combination with triamcinolone acetonide was more effective than triamcinolone acetonide and lycopene of group I and II respectively when used singly in improving the symptoms and signs of OSMF.

A Cross Sectional Study of Tubotympanic Chronic Suppurative Otitis Media with Reference to Sinonasal Pathology

In tubotympanic Chronic Suppurative Otitis Media (CSOM) the persistent inflammation of mucosa leads to irreversible changes in the middle ear and mastoid cavity. The Eustachian tube has several functions that facilitate the communication of the middle ear cavity with the nasopharynx, nasal cavity, nasal mucosa, and indirectly also with the paranasal sinuses and plays an important role in the disorders of middle ear. The Eustachian tube dysfunction and non-ventilation of middle ear cleft leads to vacuuming once the entrapped air gets absorbed by the mucosal capillaries leading to CSOM. A disease of the nose and paranasal sinuses influences causes dysfunction of the Eustachian tube leading to a middle ear infection. We wanted to study the correlation between nasal and paranasal sinus pathologies and their role in the management safe CSOM. MethodsIn this observational study, a total of one hundred cases of CSOM in the age group of 20 - 60 years was included in the study as per set criteria over a period of 6 to 7 months. All cases with persistent ear discharge were treated medically before undergoing functional endoscopic sinus surgery and septoplasty simultaneously whenever indicated after routine investigations, diagnostic nasal endoscopy (DNE), computed tomography of paranasal sinuses (CT - PNS) and otoendoscopy. A lesion causing dysfunction of ET in nasopharynx such as anatomical variants like medialised uncinate process, enlarged bulla ethmoidalis, enlarged middle turbinate, accessory ostium and deviated nasal septum (DNS) were searched and noted during DNE, FESS, and in CT - PNS. Postoperatively all cases were followed for 3 months using a nasal endoscope and otoendoscope to assess overall improvement. ResultsThere were 55 males and 45 females, with the male : female ratio of 1.22 : 1. Majority of cases were from the age group of 31 - 50 years (59 %). Among the 100 cases of CSOM, deviated nasal septum (62 %) was the most common sinonasal pathology and the majority of the cases (56 %) had ipsilateral mucopurulent discharge in the middle meatus. Confirmatory finding of DNS was 62 % with CT (p < 0.003). There was a significant association between the successful treatment of sinonasal pathology and improvement in the status of CSOM (P < 0.003). ConclusionsIn this study, DNS is the commonest aetiopathological factor for the development of CSOM apart from medialised uncinate process and hypertrophy of middle turbinate. Documentary evidence of CT scan for confirmation of DNS in the management of active safe CSOM having sinonasal pathology was important.

Acute Disseminated Encephalomyelitis (ADEM) versus Multiple Sclerosis (MS)- A Diagnostic Challenge in an Adult.

Acute Disseminated Encephalomyelitis (ADEM) is a demyelinating disease of Central Nervous System (CNS). It usually is followed by infection and vaccinations. It commonly occurs in the paediatric age group. Its occurrence in adults is rare. When present in adults, a diagnostic dilemma always occurs between ADEM and Multiple Sclerosis (MS), because of overlapping clinical, and neuroimaging features. We present a case of a 46 year old female who presented to us with variable neurologic manifestations and later was diagnosed with ADEM. This case tries to embark on arguments so as to differentiate ADEM from MS while dealing with such cases.Acute Disseminated Encephalomyelitis (ADEM) and Multiple Sclerosis (MS) are both considered as immune mediated inflammatory demyelinating diseases of the central nervous system.1,2 Although considered as different conditions, the clinical presentation of both these conditions may overlap. The only gold standard differentiation is pathologically determined. Perivenous demyelination is a feature of ADEM and discrete confluent demyelination (plaque) is signature of MS. Still hybrid cases showing pathological features of both ADEM and MS may co-exist.ADEM, typically though not always is preceded by some infection or vaccination. The course of ADEM is usually monophasic and prognosis is better than MS which commonly presents with a relapsing and remitting course. Each exacerbating event worsens the clinical course in MS. Different clinical and/or radiological criteria to differentiate between the two spectrums of diseases have been proposed, but none of those unequivocally differentiate them.Hartung and Grossmann hypothesized that ADEM may be a part of the MS spectrum, rather than a different entity.3 The characteristic demyelination in ADEM is perivenous as opposed to MS where the demyelination is confluent. 4Acute Disseminated Encephalomyelitis (ADEM) is a demyelinating disease associated with inflammation and demyelination of the Central Nervous System (CNS) in a monophasic pattern. ADEM occurs commonly in paediatric age group often following viral infections, bacterial infections, or vaccinations.[5,6] The clinical characteristics include a sub-acute development of focal neurologic deficits, accompanied by encephalopathy. 5,6 It can rarely occur in middle-aged or elderly adults. The course is usually fulminant, but typically there is recovery in 50–75% of cases, with progression to multiple sclerosis in up to 20% of cases.[5,6]

Physical fitness and physical activity level in school going adolescent children

Background: Adolescence is transitional phase between childhood and adulthood characterized by marked acceleration in growth. The objective of this study was to evaluate differences between the boys and girls in physical fitness and the variation in their physical activity at school going children at Pune.Methods: The study was carried out at various schools in Pune city. Government, government aided (semi government), and private schools were selected according to different zones of the city using random sampling method. A self-administered youth physical activity questionnaire (Y PAQ) has been given for testing their level of physical activity. Physical fitness test such as curl-up test, 90° push-up test, trunk lift, back saver sits, and reach test were performed for analysing the physical fitness of the students.Results: A total of 296 students, 142 boys (aged 13.47±0.04 years) and 154 girls (aged 13.40±0.03 years) were included in the study. The average/mean comparison demography between boys and girls for curl-up test showed 21.61±10.00 and 15.21±7.24 repetitions/min respectively. The average of 900 push-ups test between boys and girls were 12.72±7.31 and 5.12±3.25 repetitions/min respectively. The average/mean of Trunk lift test was 5.67±2.56 in boys and 5.12±2.45 inches in girls respectively.Conclusions: The study concluded that there was lower fitness level as per calculation of healthy fitness zone seen amongst the school going children and also there were lower levels of their physical activity in day to day life. Also, study results show significant difference among the boys and girls in their physical fitness level.

Empathy In Caribbean Medical Students Assessed Using The Toronto Empathy Questionnaire

Introduction: Empathy is the emotional process to understand a patient’s state of being and current emotion.Empathy, through humanization of medical students, plays an important role while learning and practicing theart of medicine. Our study aims to quantify empathy as an indicator of humanization, in medical studentsthroughout their education.Subjects and Methods: A cross-sectional questionnaire survey was performed on basic medical and clinicalscience students at Avalon University School of Medicine, Curacao. Standard Toronto Empathy Questionnaire[TEQ] was utilized to quantify the empathy.Results: Average TEQ scores of the basic students in MD1 - MD4 were 51.55 ± 4.16, 49.42±3.58, 46.72±4.60,48.86±6.17 respectively. Overall TEQ scores were slightly higher in basic science students in comparison to theclinical students (48.82 ± 5.12 vs 48.74 ± 4.01, P=0.46).Conclusions: Empathy scores were higher in basic science medical students in comparison to the clinicalstudents. Lack of progression of empathy amongst medical students needs to be addressed. We recommendmedical schools to adapt and instill the virtue of empathy in the course curriculum

Histone H2A isoforms: Potential implications in epigenome plasticity and diseases in eukaryotes

Epigenetic mechanisms including the post-translational modifications of histones, incorporation of histonevariants and DNA methylation have been suggested to play an important role in genome plasticity by allowingthe cellular environment to define gene expression and the phenotype of an organism. Studies over the pastdecade have elucidated how these epigenetic mechanisms are significant in orchestrating various biologicalprocesses and contribute to different pathophysiological states. However, the role of histone isoforms and theirimpact on different phenotypes and physiological processes associated with diseases are not fully clear. Thisreview is focussed on the recent advances in our understanding of the complexity of eukaryotic H2A isoformsand their roles in defining nucleosome organization. We elaborate on their potential roles in genomic complexity and regulation of gene expression, and thereby on their overall contribution towards cellular phenotypeand development of diseases

Blunt abdominal trauma: the experience in rural India and review of literature

Background: Blunt Abdominal trauma is one of the most common injuries caused due to road traffic accidents. The rapid increase in number of motor vehicles and its aftermath has caused rapid increase in number of victims due to blunt abdominal trauma. As the care of patients with blunt abdominal injuries is largely a surgical responsibility and abdominal injuries involving major hemorrhage from solid viscera constitute surgical emergencies. Abdominal blunt traumas represent a real diagnostic and therapeutic challenge to even a most experienced surgeon, thereby representing importance of its study. Early diagnosis and effective management help in decreasing mortality in blunt abdominal trauma.Methods: Prospective study of 50 patients admitted to the institute with history of Blunt Abdominal Trauma. After initial resuscitation of the patients, thorough assessments for injuries were carried out in all the patients. Documentation of patients, which included identification, history, clinical findings, diagnostic test, operative findings, operative procedures and complications during the stay in the hospital were all recorded on a Performa specially prepared. The management was decided depending upon history, clinical examination and investigations.Results: Males were predominantly affected, and most cases were between the age group of 21-40 years (76%). Majority of the patients (90%) presented with the complaint of abdominal pain followed by abdominal distension (56%). 36(60%) patients were managed conservatively while operative interventions were required in 24(40%) patients. The common surgeries performed in the patients included splenectomy, primary closure of perforation and resection and anastomosis of bowel. Majority of the patients (80%) were discharged within 20 days of admission. The mortality in present study was 13.3%.Conclusions: Blunt Abdominal Trauma is one of the important causes of morbidity and mortality in young adults. Immediate resuscitative measures, management of associated injuries and appropriate operative intervention are important parts of management of such cases.