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Fiberoptic bronchoscopy (FOB) has simplified the direct examination of the lungs and is widely used for diagnosis and therapy. Fiberoptic bronchoscopes occupy a significant proportion of cross-section area of central airways, which can affect lung mechanics and gas exchanges that may lead to desaturation and cardiac arrhythmia. This makes bronchoscopy in critically ill patients with respiratory failure even more challenging. Use of noninvasive mechanical ventilation (NIV) may help to avoid use of invasive mechanical ventilation in selected patients with acute respiratory failure. It has been shown to be useful in hypoxemic patients to facilitate bronchoscopic examination for bronchoalveolar lavage, bronchial brushing, endobronchial biopsy (EBB), and transbronchial lung biopsy (TBLB). Noninvasive mechanical ventilation has also been used to facilitate other endoscopic procedures including transesophageal echocardiography (TEE) and upper gastrointestinal endoscopy for diagnostic and therapeutic interventions in hypoxemic patients. Endobronchial ultrasound (EBUS) bronchoscope, having a wider diameter than a conventional bronchoscope, may have a more pronounced effect on lung mechanics and gas exchanges, and its use in patients on NIV has not been reported. Contraindications of EBUS are mostly relative and similar to FOB. There are several studies suggesting the safety of NIV-supported FOB in hypoxemic patients. We describe our experience of the first two EBUS bronchoscopies and transbronchial needle aspiration (TBNA) was done in hypoxemic patients with NIV support.
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Background: COVID-19 is a global pandemic started from Wuhan China in December 2019 and involved whole world including India. India has reported 3.48 crores cases and 4.81 lakhs death till December 31, 2021. Madhya Pradesh is among the top ten case load states in India affected by COVID. Initially, there was involvement of urban area of large cities followed by small rural area of Madhya Pradesh. Aims and Objectives: The aim of the study was to describe the epidemiological determinants of the COVID-19 in Sironj block of Vidisha district of Madhya Pradesh. Materials and Methods: This was a community-based cross-sectional study which included all laboratory positive COVID-19 cases from first reported case from April 3, 2020 to August 3, 2020 (first wave). The information was collected through predesigned proforma with the help of health workers in health services. MS Excel software used for data analysis. Results: Out of 132 positive cases, the majority of cases were between 15 and 35 years of age group with 2/3 cases of male predominance. More than 58% patients were asymptomatic at the time of diagnosis. There were on average 57.39 cases/Lakh population found during the study period while sample positivity rate was 13.73%. Cases were scattered around 41 major areas of Sironj block. Peak cases were observed around past 2 weeks of July 2020 during first wave of COVID-19. Conclusion: The focus must be placed around the ward/village where the number of active cases of COVID-19 is concentrated. It must be reconsidered on time to time basis.
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Crops need large quantity of potassium for enhancing their yield as well as quality. Pulses are important crops grown in India but their productivity is low. Among production inputs, recommendations for N and P fertilizers are made in most states with no K application resulting in imbalanced nutrient supply and lower crop yields.To quantify optimum dose for green gram ( Vigna radiata L.), a series of field experiments were conducted at Regional Research Station, CCS HAU, Bawal, Haryana, to assess the response of green gram to fertilizer potassium on coarse textured (Typic Haplustepts) soils of southern Haryana. After completion of research trials, crop was tested on farmer’s field through demonstrations and on farm trials (OFTs) to evaluate the response and adoptability of green gram as per the fertilizer potassium doses concluded in research experiment. Five levels of fertilizer potassium (0, 10, 20, 30 and 40 kg K2O ha-1) were evaluated for the response of green gram in randomized block design replicated thrice. The results of research trials revealed that the yield, protein content and growth parameters of green gram increased significantly with the application of fertilizer potassium @20 kg K2O ha-1. Significantly higher yield of green gram was recorded (5.87, 16.29, 19.23 and 22.36 %) due to application of 10, 20, 30 and 40 kg K2O ha-1, respectively over control. The total K uptake by green gram increased significantly with the incremental doses of potassium application which helped to prevent the depletion of available soil K and build-up its content in the soil. The mean K use efficiency varied from 38.30 to 54.15 and maximum (54.15 %) was recorded with the application of 20 kg K2O ha-1. The benefit cost ratio was also increased with the application of potassium and reflected in terms of additional returns per rupee (Rs. 10.94, 15.63, 12.17 and 10.72) invested on application of K @ 10, 20, 30 and 40 kg K2O ha-1, respectively. The farmer’s field trial results with 0 and 20 kg K2O ha-1 revealed that application of 20 kg K2O ha-1 increased the yield of green gram by 10.87% over control.
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Present study was undertaken to study the neurotoxicity of oral acrylamide (ACR) and its amelioration using α-tocopherol, reduced glutathione (GSH) and hot aqueous extract (HAE) of Ocimum sanctum. Forty five male Wistar rats were divided into 12 groups. The study showed a significant reduction in the body weight of the rats fed with ACR in comparison to the other groups while body weight was restored in the rats fed with α-tocopherol and HAE. Neurotoxicity in rats fed with ACR was evident with the results of histopathology and oxidative stress (high MDA and decreased activities of GSH, SOD, GST and CAT in brain). Co-administration of α-tocopherol and HAE lowered these changes however, there was no marked improvement seen in neural damage but improvement was evident in behavioral as well as physiological changes at a marked point. Histopathology of brain in ACR alone fed group showed extensive neural degeneration and massive deposition of fibrin which was substantially decreased and ameliorated with the co-administration of α-tocopherol and HAE. These results support the oxidative stress results as well. Our results suggests that α-tocopherol and HAE can be useful for protecting brain tissue against ACR induced neurotoxicity through minimizing the free radical mediated oxidative stress
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Spermatozoa undergoes array of signaling and intracellular pathways and ultimately become competent enough to accomplish fertilization. Hormones, ion channels and signaling molecules in both male and female reproductive tract show bidirectional cross play. The recent discovery of endocannabinoids and their receptors in male and female reproductive system opened new vistas for their research in regulating sperm function. Interestingly, endocannabinoids regulate sperm motility, capacitation, hyperactivity and eventually acrosome reaction. However, their complex intracellular pathways are still to be understood in regulating spermatozoa function. The present review highlights the major breakthrough research in the area of endocannabinoids in male reproduction and in more specific in sperm cells, and their association with regulation of sperm fertilizing competence
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Background: Anterior Support Ankle Foot Orthosis (A-AFO) is a fairly recent approach. There is dearth of studies relating to comparison of metabolic efficiency of A-AFO and P-AFO. Objective was to study the efficacy of A-AFO compared to P-AFO in foot drop patients, using gait and metabolic analysis.Methods: It was a cross over study, included foot drop patients who could walk with/ without orthosis. Patients having spasticity more than grade 2 (Modified Ashworth Scale) were excluded. The metabolic parameters measured were volume of Oxygen consumed at Standard Temperature and Pressure in l/min (VO2), Dry in l/min, Rate of Oxygen consumption (MET), Volume of Carbon dioxide produced in litre/min (VCO2). Along with various gait parameters, questionnaire about patient’s preference after 4 weeks was also incorporated.Results: A-AFO was significantly better than P-AFO in terms of VO2 and VCO2 (p value = 0.02 and 0.009 respectively) as well as in terms of subjective preference.Conclusions: A-AFO is comparable to P-AFO in terms of energy efficiency, gait parameters and subjective preference, hence should also be prescribed.
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Aim: The objective of the present study was to assess the impact of conjunctive use of wool waste, farm yard manure and chemical fertilizer on soil properties of Aridisol of Bikaner, Rajasthan, India. Methodology: After harvest of cabbage crop, soil samples were collected from the respective experimental plot of crop field by adopting the standard procedure. Bulk density, particle density, pH, electrical conductivity, organic carbon, available N, P, K, S, Zn, Cu, Mn, Fe, microbial count and dehydrogenase activity were estimated following the standard protocol. Results: Application of wool waste @ 7.5 t ha-1 along with FYM @ 7.5 t ha-1 (W1) significantly increased organic carbon and plant available nutrients (N, P, K, S, Zn, Cu, Mn, Fe) over control and rest of the treatment. but W1 and W2 (Wool waste @ 5 t ha-1 along with FYM @ 10 t ha-1) treatment was found at par with respect to nitrogen. Treatment W1 also gave significant performance of microbial count and dehydrogenase activity during experimental season over rest of the treatment. Application of each increasing level of recommended dose of fertilizer significantly enhanced all chemical and biological properties of soil. Application of wool waste @7.5 t ha-1 along with FYM @7.5 t ha-1 increased available macronutrients and micronutrients over control. Interpretation: It can be concluded that conjunctive use of wool waste, farm yard manure and inorganic fertilizer proved better nutrient management option for improving soil properties.
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Epstein–Barr virus (EBV) promotes the development of undifferentiated carcinomas of the upper aerodigestive tract and different types of lymphomas. This ability of tumorigenesis is heightened in many immunocompromised patients who have an increased incidence of lymphoproliferative disorders. The virus also induces smooth muscle proliferation, and those occurring following transplantation are designated as EBV-associated post-transplant smooth muscle tumors. We report multifocal miliary-sized leiomyomas in the lungs in a renal transplant recipient as an incidental finding.
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Good paraffin sections are key to correct histopathological diagnosis. Xylene is hazardous to health, expensive, and difficult to dispose. Various substitutes have been tried without success. We aimed to examine if 1.7% dishwasher soap (DWS) aqueous solution and refined mineral oil (RMO) for deparaffinization can replace xylene. Fifty tissue blocks consisting of benign and malignant lesions were processed using xylene (A), 1.7% DWS (B), and RMO (C). Each section was evaluated, scored as 0 (inadequate) and 1 (adequate) by two independent pathologists who were blinded to agent used. Following criteria were considered: nuclear staining, cytoplasmic staining, clarity, crispness, and uniformity. Total score of <2 was graded as inadequate for diagnosis and 3–5 as adequate. Statistical analysis was done using the SPSS software by applying chi-square test. Among three methods, B had the best scores in adequacy for cytoplasmic staining (P = 0.001), clarity (P = 0.004), and crispness (P = 0.003). About 1.7% DWS and RMO were found to be effective methods for deparaffinization and can replace xylene.
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Background: Cytological examination of pericardial effusion fluids is important in diagnosing the etiology of underlying disease, staging, and prognosis of cancer. Aims and Objectives: (1) To study cytological evaluation of pericardial effusions in various pathological conditions in a tertiary care center. (2) To analyze their frequency and clincopathological correlation of the diagnosis. Materials and Methods: Our study was a retrospective study performed in the Department of Pathology from 1st January 2012 to 31st December 2016. The study sample included all the pericardial effusions submitted in the pathology department for cytological evaluation. Clinical details and relevant parameters correlated with clinical findings. Each fluid underwent cytospin and cytocentrifuge along with preparation of conventional smears. Results: Of 120 cases, 80% were of benign effusion and 20% were of malignant effusion. Male-to-female ratio was 1.44:1 with patient age ranging from 3 to 90 years. Conclusion: Benign effusions can been seen in younger age group and malignant ones in the older age group. The preliminary pericardial fluid analysis in resource-limited settings is the most convenient and cost-effective method for accurate diagnosis. It reduces the demand of invasive investigations and its complications. At times, it is the first test to point toward underlying malignant process thereby affecting the prognosis, survival, and treatment outcome of the patient.
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Surgical skill enhancement for the residents under training can be performed through various efforts. Here in this report, the authors describe a technique of corneoscleral perforation repair on goat's eye, as the tissue resemblance and the reality of experience while performing crucial steps are similar to human eyes. Beginning from tissue handling, optimal suture placement was taught with an intention to impart quality techniques of traumatic globe injury repair. Therefore, rather than training on expensive artificial eye model, training budding surgeons on goat's eye gives much more realistic tissue handling experiences in the presence of constant challenges almost similar to human eyes.
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Purpose: To determine the comparability of anterior chamber biometric measurements in primary angle closure disease (PACD) patients using two commercially available anterior segment optical coherence tomography machines (ASOCT): Visante and Casia. Methods: This was a cross-sectional observational study, which included clinically, diagnosed cases of PACD. Anterior segment biometric measurements were done using Casia and Visante ASOCT. Parameters studied were central corneal thickness (CCT), anterior chamber depth (ACD), nasal (N) and temporal (T) angle opening distance at 500 ?m (AOD500) and 750 ?m (AOD750), and N and T trabecular iris space area at 500 ?m (TISA500) and 750 ?m (TISA750). Results: Total 36 PACD patients (72 eyes) with average age of 59.48 ± 7.95 years were recruited, out of which 25 were females (69.44%) and 11 males (30.56%). The mean measurements of CCT, ACD, AOD500, and TISA on Casia and Visante machines were 522.5 ± 34.75 ?m and 539.55 ± 29.56 ?m (P = 0.00); ACD- 2.144 ± 0.38 mm and 2.133 ± 0.39 mm (P = 0.487); AOD500-0.27 ± 0.16 ?m and 0.21 ± 0.10 ?m (P = 0.04); and TISA500-0.100 ± 0.07 ?m and 0.063 ± 0.03 ?m (P = 0.00), respectively. A statistically significant difference was noted in CCT, N and T AOD, and TISA. A good corelation for ACD and CCT (ACD = 0.9816 and CCT = 0.772) only were noted between the two machines. The Bland-Altman plot analysis of different parameters between two machines has revealed good agreement of measurement of ACD and CCT but poor agreement for rest of the parameters. Conclusion: It is advisable not use the two machines interchangeably because of the wide limits of agreement and poor correlation of angle measurement values of Casia and Visante ASOCT.
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Penicilliosis is a rare opportunistic fungal infection caused by Talaromyces marneffei, especially in the HIV-infected patients. The untreated disease is highly fatal. The infection is endemic in Southeast Asia and Northeast India. The present case is the first case of disseminated penicilliosis from North India and Delhi in a 31-year-old male, recently diagnosed with HIV. This case highlights the importance of considering an unusual organism as the cause of disseminated disease in the nonendemic area.
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Context: In India, lung carcinoma is the fifth-most common tumor and second-most common tumor in the males as per the Indian Council of Medical Research registry of 2002. It has been seen that ALDH1 expression in non-small cell lung cancer (NSCLC) and the presence of marker was linked to a more tumorigenic potential in the in vivo assessment and shorter disease-free survival in NSCLC patients with platinum treatment. Aims: Hence, our objective was to detect association of cancer stem cell (CSC) marker aldehyde dehydrogenase 1 (ALDH1) with clinicopathological profile in lung carcinoma patients. Settings and Design: This is a Pilot study. Subjects and Methods: It was a Pilot study where biopsies from 55 fresh previously untreated lung cancer patients visiting the Pulmonary Medicine Department of Era's Lucknow Medical College and Hospital Lucknow and King George's Medical University were taken for 18 months November 2014–April 2016, after taking proper informed consent from them. Paraffin blocks were taken and stained by hematoxylin and eosin (Sigma) to make the histopathological diagnosis and immunohistochemistry was done for detection of CSC marker ALDH1 (Daco). Statistical Analysis Used: The statistical analysis was done using Statistical Package for Social Sciences Version 15.0 Statistical Analysis Software. The values were represented in number (%) and mean ± standard deviation. Results: Expression of stem cell marker ALDH1 with the staging of the tumor was observed in 62.5% of Stage I, 80% of Stage II, 94.1% of Stage III, and 100% of Stage IV cases. Statistically, there was a significant association between ALDH1expression and stage of disease (P < 0.001). Diagnostic efficacy of ALDH1 expression in the detection of any positive clinical stage, it was found to be 88.6% sensitive and 90.9% specific. Conclusions: Strong ALDH1 expression correlates with higher stage of lung carcinoma making it a prognostic marker needing in-depth study.
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Trophoblastic differentiation of endometrial carcinoma is extremely rare, till date 18 cases reports are there in the literature. A 68-year-old postmenopausal female presented with abnormal vaginal bleeding. Histopathologically, there were areas of serous carcinoma with trophoblastic differentiation (~90%). On immunohistochemistry, the trophoblastic component was positive for ?-human chorionic gonadotropin (hCG), HPL and EMA. IHC confirmed the diagnosis of serous carcinoma with trophoblastic differentiation. The clinicopathological features of 18 previously reported cases of trophoblastic differentiation in the uterine tumor were analyzed in addition to the present case.
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Background and Objectives: Acute appendicitis is one of the commonest surgical emergencies of the abdomen worldwide. Even with the availability of current imaging investigation like USG , CT scan and MRI, the diagnosis is still a problem. Delay in diagnosis increases mortality and morbidity. Liver function test is one of the biochemical parameters being assessed as a marker of acute appendicitis and may also predict the severity of the inflammation. However the available literature is limited and views are conflicting. In this study, it is proposed to access the validity of using liver function test to predict the appendicitis and its severity.Material and Methods: This is a prospective study of 80 cases of operated patients of acute appendicitis in Universal College Of Medical Sciences, Bhairahawa, Nepal during the period from 6th May 2013 to 6th July 2014. Data were collected from the patient by their clinical history, examination and investigations, Liver function test and ultrasound. Post operative follow up was done to note for complications and histopathology findings. Data collection was compiled in a systemic way in preformed proforma and analyzed.Results: Out of 80 patients, 44(55%) were male and 36(45%) were female. Total serum bilirubin was elevated in 29 (36.25%) of the patients. Rise in serum bilirubin was mixed type with direct bilirubin Predominance. In Liver enzymes ALT, AST, ALP were raised in 32.5%, 28.75% and 82.5% respectively. Hyperbilirubinemia has the specificity (80 %) sensitivity (37.33%) with good positive predictive value of 96.55%. Similarly sensitivity and specificity of direct bilirubin (90.67%, 20.00%), Indirect bilirubin (16.00%, 80%), AST/SGOT (30.67%, 100%), ALT/SGPT (34.67%, 100%) ALP (84.00%, 40%) respectively. The positive predictive value for direct bilirubin, indirect bilirubin, AST/SGOT, ALT/SGPT and ALP are 94.44%,92.31%,100%,100% and 95.45% respectively.Conclusion: Liver function test is a marker for acute appendicitis and its complication with a good positive predictive value. Liver function test should be used together with clinical examination and other laboratory investigations in the assessment of patients with suspected acute Appendicitis.
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A term male infant presented with generalized hypotonia, paucity of lower limb movements, and diminished muscle stretch reflexes. At 3 weeks of age, motor nerve conduction studies demonstrated evidence of demyelination and axonal involvement. These findings indicated demyelination and patient was diagnosed to have congenital Guillain-Barre syndrome. Improvement was seen after a course of IVIG. We are reporting this case because of rarity of its occurrence and should be considered in differential diagnosis in floppy neonate.
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Non-Hodgkin’s lymphoma often presents outside the lymphoid system. Among the salivary glands, parotid is exclusively involved and it is extremely rare in submandibular gland. We report a case of non-Hodgkin’s lymphoma in submandibular gland, which was initially managed as a case of chronic submandibular sialadenitis, but later on confirmed as non-Hodgkin’s lymphoma after surgical excision and histopathological examination.