Clinical features of Vitamin D deficiency in children and their correlation with Vitamin D levels: A cross-sectional study in SRVS medical college, Shivpuri

Background: Vitamin D along with calcium plays an important role for the maintenance of musculoskeletal health during whole life, and it is essential to address their deficiency pediatric and adolescent population is vital. Ideally, all the children should be screened for Vitamin D deficiency because a large number of Vitamin D deficient are asymptomatic, but it is practically difficult to do Vitamin D levels in all the healthy children. Aims and Objectives: The aim of the study is screening children presenting with signs and symptoms suggestive of Vitamin D deficiency and tried to correlate the presenting clinical feature with the level of Vitamin D with the following objectives: (i) to study the level of Vitamin D (25 hydroxy Vitamin D) in apparently healthy children with clinical features indicating of Vitamin D deficiency and (ii) to correlate the specific clinical features with Vitamin D level. Materials and Methods: This study was approved by the institutional ethics committee, and informed consent was obtained by writing from the parents before starting of the study. Cross-sectional observation study conducted between November 2021 and November 2022 by convenient sampling method. Young children and adolescents of age group of 2–14 years attending OPD at SRVS Medical College Shivpuri was the study population. Results: The present study done in Shivpuri belt the prevalence deficiency of Vitamin D was found to be 52% in children. Prevalence of Vitamin D deficiency in Madhya Pradesh is high, pointing as the severe and critical public health issue. Conclusion: Vitamin D deficiency done by serum concentrations of 25 (OH) D if less values proper suggestive treatment is recommended.

Normal and Abnormal Development of Left Vertebral Artery and Its Implications in Cervical Region Surgery

Aortic arch (AA) anomalies occur in approximately 3-5% of cadavers, but these atypical branches remain a point of discussion in cervical region surgery. This case report describes a 73-year-old Caucasian female who died of renal failure following a complicated urinary tract infection whose left vertebral artery (LVA) originated from the AA between the left common carotid and subclavian arteries. The preforaminal part of the LVA was 5 mm in diameter and entered the C6 transverse foramen while the right vertebral artery (RVA) arose from the right subclavian was 6.5 mm in diameter and entered the C5. Embryologically, VAs are formed during weeks four through eight by development of longitudinal anastomoses linking the cervical intersegmental arteries (ISA). The ISA regress except the seventh, which becomes the proximal subclavian artery, the point of origin of the adult VA. Persons with LVA that arises from the AA may be asymptomatic; however, secondary dilatation of the RVA may be implicated in the development of cerebrovascular disorders and atherosclerotic changes due to increased blood flow. Additionally, the anatomical positioning of a left vertebral artery is important when considering an anterior approach for cervical spine surgery and other head-neck procedures when soft structures arteries, veins and muscles are retracted to reach the cervical spine.

Retention of basic and clinical concepts in Anatomy and the effect of multiple testing

Background@#Clinical competency depends on student's knowledge of basic sciences including the learned concept in Anatomy. But what if students forget the learned knowledge of human anatomy? @*Objectives@#This research investigated knowledge gain post instruction, knowledge retention (or loss) of basic and clinical concepts five months after. It also compared the effect of delayed-multiple testing and delayedsingle testing in the retention of acquired knowledge. @*Methodology@#This is an experimental study conducted among first year medical students who underwent neuroanatomy module and later followed-up after five months using a 32-item test-retest. Items were categorized as basic knowledge and clinical correlation. Participants were randomly assigned into two groups; delayed-multiple and delayed-single testing. Mean difference in scores between the 2 testing periods (end-ofmodule and terminal delayed test) were analyzed using paired samples t-test while mean difference between basic and clinical correlation were analyzed using independent samples t-test. The degree of knowledge loss was determined using the computed Knowledge Loss Percentage (KLP). @*Results@#Knowledge gain was noted at the end of instruction (p value<0.001). Knowledge loss is higher among basic knowledge (p value<0.001) and demonstrated a higher computed KLP. Repeated testing demonstrates a higher retention (KLP=4.34) compared to those administered with a single test only (KLP=26.73). @*Conclusion@#Knowledge loss occurs post instruction and more pronounced among basic concepts. Clinical correlation and frequent testing demonstrate a significant retention capability. To reduce the effect of knowledge loss among basic concepts, this study recommends the implementation of multiple testing.

¿Cuál es el valor de la autopsia neonatal? Correlación anatomoclínica en 135 casos / What is the value of neonatal autopsy? Pathological and clinical correlation in 135 cases

Introducción. La autopsia neonatal es un valioso método diagnóstico y esencial para el asesoramiento familiar sobre futuros embarazos. Población y métodos. Estudio retrospectivo que incluyó todas las autopsias de neonatos fallecidos en la Clínica y Maternidad Suizo Argentina desde enero de 1998 a diciembre de 2006. Se determinó la tasa de autopsias y se compararon los diagnósticos obtenidos de las historias clínicas con los resultados de estas. Resultados. Sobre el total de 227 niños fallecidos,se realizaron 135 autopsias (tasa de 59,5%). En el 25%,la concordancia fue completa. En el 26%, se halló nueva información con significativa implicancia para el asesoramiento genético. Conclusiones. La tasa de autopsias fue del 59,5%. La correlación anatomoclínica y sus insospechados hallazgos con implicancia para el asesoramiento genético muestran la importancia de la práctica sistemática de la autopsia neonatal.

Introduction. Neonatal autopsy is a valuable, critical diagnostic method to provide genetic counseling for future pregnancies. Population and methods. Retrospective study including all neonatal autopsies performed on deceased neonates at Clínica y Maternidad Suizo Argentina between January 1998 and December 2006. The rate of autopsies was established; the diagnosis indicated in the medical record was compared to autopsy findings. Results. Out of 227 deceased infants, 135 autopsies were performed (rate: 59.5%). Concordance was complete in 25% of autopsies. New information was found in 26%, which had significant implications for genetic counseling. Conclusions. The rate of autopsies was 59.5%. Pathological and clinical correlation and unsuspected findings with implications for genetic counseling demonstrate the relevance of performing neonatal autopsies systematically.

Changes and clinical correlation of serum IL-4 level for patients with chronic hepatitis B / 国际检验医学杂志

Objective To investigate the changes and clinical correlation of IL-4 in patients with HBV infection.Methods Sixty cases with chronic asymptomatic HBV carriers,60 cases with chronic hepatitis B,60 cases with liver cirrhosis,60 cases with hepato-cellular carcinoma and 50 healthy controls were collected for serum.ELISA was used for detection of cytokine IL-4 levels;The a-mount of HBV DNA was measured by fluorescence quantitative PCR;Liver function was tested by automatic biochemical analyzer. Results Compared with the healthy controls[(1.64±0.17)ng/mL],IL-4 levels of patients with CHB,LC and HCC were signifi-cantly increased[(4.18±0.48),(4.71±0.42),(3.62±0.31)ng/mL,P <0.05].LC group have the highest IL-4 levels,while ASC was the lowest.Compared with the ASC group,IL-4 levels of patients with CHB,LC and HCC were significantly increased(P <0.05).Compared with the HCC group,IL-4 levels of patients with LC were significantly increased(P <0.05).IL-4 level was posi-tively correlated with TBIL levels in LC patients(r=0.529,P <0.01),while the IL-4 level was positively correlated with ALT and TBIL level in HCC patients(r=0.263,0.323,P <0.05).Conclusion IL-4 may play an important role in chronic HBV infection, the levels of IL-4 can be used as an important indicator to assess the severity of chronic hepatitis B.

Number of leprosy reactions during treatment: clinical correlations and laboratory diagnosis

Abstract INTRODUCTION: The occurrence of leprosy reactions, a common event during treatment, may be mostly related to the action of multidrug therapy on Mycobacterium leprae. The clinical and laboratory monitoring of patients with reactions is important, since collecting data that assists in predicting the risk of reactions may help to prevent disability. METHODS: This was a sectional study, in order to correlate clinical and laboratory diagnosis with the number of reactions during treatment. Spearman's correlation was used to verify the degree of association between the assessed variables. RESULTS: This study was conducted with 211 patients with leprosy reactions during treatment of M. leprae. The borderline tuberculoid group was the most prevalent clinical form (74/211; 35.1%) and the type one reaction showed the highest frequency (136/211; 64.5%). It was observed that 73.5% (155/211) of reactions occurred within 3 months of the initiation of multidrug therapy. The diagnostic values, including the bacterial indices (BIs) of dermal smears (r = 0.21, p < 0.05) and skin biopsies (r = 0.20; p < 0.05), showed a positive correlation with the number of reactions during treatment. CONCLUSIONS: This research showed a positive correlation between bacillary load markers and the number of leprosy reactions. This study provided scientific support to future research aiming to elucidate the influence of antigenic load on the number of leprosy reactions during treatment.

Clinical correlation of Pseudomonas aeruginosa isolated from clinical settings at Civil Hospital, Ahmedabad.

Introduction: Pseudomonas aeruginosa species can be dangerous opportunistic pathogen because of its tolerance to physical, chemical, antibacterial compounds. In hospitals, P. aeruginosa is a formidable opportunistic pathogen, and therefore, the medical concern with infection of immunologically compromised patients in burns and neonatal units, is well justified. Material and methods: Total 1583 samples like swab, urine, sputum, pus, pleural fluid, bronchoalveolar lavage (BAL), ascitic fluid and blood samples from different clinical departments were tested at Clinical Microbiology Department of B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat during April 2009 to April 2010. Results: Out of 1583 samples, 807 samples turned culture positive. Out of 807 culture positive samples, 100 were culture positive for P. aeruginosa. The maximum number (68%) of P. aeruginosa isolates were obtained from swab samples. The highest number of such isolates (48%) belonged to surgical ward. P. aeruginosa showed highest sensitivity against Cefepime - Tazobactam (97%). Conclusion: This study showed that P. aeruginosa is acquiring resistance to commonly used antibiotics as well as newer antibiotics. The antimicrobial agents are losing their efficacy because of spread of the resistant organism, indiscriminate use of antibiotics, and unhygienic condition. It is the need of the time that antibiotic policies should be formulated and implemented to resist and overcome this serious problem.

Study on HLA-DRB1 shared epitope in patients with IgA mesangial proliferative glomerulonephritis / 中国免疫学杂志

Objective:To explore the clinical correlation of HLA-DRB1 shared epitope with IgA mesangial proliferative glomer-ulonephritis( IgA MsPGN).Methods:The renal function were examined routinely,and HLA-DRB1 shared epitope were determined by PCR in a total of 164 patients with IgA MsPGN and 164 healthy subjects.The renal function and HLA-DRB1 shared epitope were compared in patients with IgA MsPGN and healthy subjects,and clinical correlation of HLA-DRB1 shared epitope and renal function were analyzed.Results:(1)24 h proteinuria,serum creatinine and serum urea nitrogen were significantly different in patients with IgA MsPGN and healthy subjects(P<0.01);(2)The high-frequency gene of HLA-DRB1 in patients with IgA MsPGN were DRB1*04, DRB1*07,DRB1*09,DRB1*11,DRB1*14 and DRB1*15;(3) The distribution frequency of DRB1*09 and DRB1*11 in patients with IgA MsPGN increased significantly(P<0.01 or P<0.05);(4)24 h proteinuria,serum creatinine and serum urea nitrogen in patients with IgA MsPGN with DRB1*09 and DRB1*11 were significantly different compared with those in patients with IgA MsPGN with other HLA-DRB1 shared epitope(P<0.01).Conclusion:HLA-DRB1 shared epitope is related to IgA MsPGN,DRB1*09 and DRB1*11 can increase the risk of IgA MsPGN,and related to the severity of glomerulonephritis.

O analista trabalhando: sonhando Santiago / El analista trabajando: soñando Santiago / The analyst at work: dreaming Santiago

Este texto constitui-se num exercício psicanalítico de correlação teóricoclínica. É apresentada uma sessão de análise considerada difícil para o analista, ou seja, na qual os recursos técnicos usualmente disponíveis são sentidos como não dando conta do recado. Partindo das indagações formuladas pelo analista a respeito dos fatos emocionais vivenciados pela dupla analítica, são tecidos dois comentários independentes sobre o encontro, ampliando os possíveis vértices de observação analítica. No primeiro comentário, intitulado O menino, a autora enfatiza os ricos elementos visuais e emocionais presentes nas falas do analisando e nas rêveries do analista, enfatizando sua natureza fundamental nos processos do sonhar (Bion, 1962). Para ilustrar suas reflexões, traz associações com Menino, personagem do livro Primeiras estórias de Guimarães Rosa. No segundo comentário, intitulado O desafio de trabalhar a partir da cesura, a autora observa a movimentação da dupla pelo vértice da cesura (Bion, 1977) e propõe reflexões a fim de explorar os fenômenos que se apresentaram na situação analítica objetivando ampliar as perspectivas de observação clínica. Destaca a importância do exercício reflexivo como oportunidade para afinarmos nossos instrumentos analíticos, enfatizando a importância da capacidade de apreensão da vivência clínica do analista para trabalhar a partir da cesura.

This text is an exercise of psychoanalytic clinical-theoretical correlation. It presents an analysis session considered difficult for the analyst, one in which the technical resources usually available are felt as insufficient. Starting from the inquiries made by the analyst on the emotional facts experienced by the analytic pair during one session, two independent comments were woven, expanding the possible vertices of analytical observation. In the first comment, entitled The boy, the author highlights the rich visual and emotional elements presented in the patient’s speech and in the analyst’s rêveries, emphasizing their fundamental nature in dreaming processes (Bion, 1962). To illustrate these ideas, the author uses associations with Boy, a character in Guimarães Rosa’s book entitled First stories. In the second comment, entitled The challenge of working from the caesura, the author observes the movements within the analytic pair from the vertex of caesura (Bion, 1977). She proposes reflections in order to explore the phenomena presented in the analytic situation with the purpose of expanding the perspectives of clinical observation. The importance of reflective clinical-theoretical exercise is highlighted as an opportunity to sharpen our analytic instruments and the importance of the analyst’s ability to work from the vertex of caesura is emphasized.

Este texto se constituye en un ejercicio psicoanalítico de correlación teórico clínica. Es presentada una sesión de análisis considerada difícil para el analista, o sea, en la cual los recursos técnicos usualmente disponibles son sentidos como insuficientes. Partiendo de las indagaciones formuladas por el analista, respecto de los hechos emocionales experimentados por la dupla analítica, son elaborados dos comentarios independientes sobre el encuentro, ampliando los posibles vértices de observación analítica. En el primer comentario, intitulado El niño, la autora enfatiza los ricos elementos visuales y emocionales presentes en las charlas del analizando y en las rêveries del analista, enfatizando su naturaleza fundamental en los procesos del soñar (Bion, 1962). Para ilustrar sus reflexiones, realiza asociaciones con el Niño, personaje del libro Primeras historias, de Guimarães Rosa. En el segundo comentario, intitulado El desafío de trabajar a partir de la cesura, la autora observa el movimiento de la dupla por el vértice de la censura (Bion, 1977) y propone reflexiones a fin de explotar los fenómenos que se presentan en la situación analítica, objetivando ampliar las perspectivas de observación clínica. Se destaca la importancia del ejercicio reflexivo como una oportunidad para afinar nuestros instrumentos analíticos, enfatizando la importancia de la capacidad de aprehensión de la vivencia clínica del analista para trabajar a partir de la cesura.

Correlación clinicometabólica del miembro superior traumático quirúrgico y bloqueo continuo del plexo braquial / Metabolic and clinical correlation in traumatic upper limb surgery and continuous brachial plexus block

Objetivo: evaluar las alteraciones en la correlación clinicometabólica del miembro superior con lesión traumática quirúrgica en pacientes que recibieron anestesia-analgesia regional por bloqueo continuo del plexo braquial (BCPB). Métodos: se realizó un estudio en 60 pacientes, todos ASA-I, divididos en dos grupos iguales: G (control), anestesia general y analgesia sistémica con dipirona 1,2 g IM cada 6 h, y B (estudio), anestesia regional por vía axilar o supraclavicular con 100 mg de bupivacaína y analgesia con igual anestésico local cada 6 h. Se correlacionaron las alteraciones clinicometabólicas a las 24 h del posoperatorio por examen clínico y gasometría capilar a ambos miembros superiores. Resultados: predominaron el sexo masculino y los grupos de edades de 30-44 y 45-59 años en ambos grupos (p = 0,05). Las fracturas múltiples y simples constituyeron el 60 % del total de la muestra de los grupos G y B respectivamente (p = 0,05) y predominó el tratamiento de urgencia en ambos grupos (p = 0,05). Se percibió frialdad en el miembro lesionado en 70 % de los pacientes del grupo G, y 13,3 % del B (p = 0,01). Se constató un llene capilar lento en 53,3 % de los pacientes del grupo G y 10 % del B (p = 0,01) y se observó palidez de la mano en 56,7 y 10 % de los pacientes de los grupos G y B respectivamente (p = 0,01). Se comprobó HbO2 £ 89 % en el miembro lesionado en 60 y 6,7 % de los pacientes de los grupos G y B correspondientemente (p = 0,01), y se corroboró una diferencia de HbO2 > 5 % entre los miembros superiores: 76,7 % de los pacientes del grupo G y 16,7 % del B (p = 0,01). Conclusiones: el método de anestesia-analgesia regional por bloqueo continuo del plexo braquial es superior en cuanto a ventajas, ya que existe una reducción en cuanto a alteraciones en la correlación clinicometabólica en el miembro superior lesionado.

Objective: to assess changes in metabolic clinical correlation with traumatic upper limb surgery in patients receiving regional-analgesia anesthesia by continuous brachial plexus block (DNB). Methods: 60 patients were studied. All of them were ASA-I, and they were placed into two equal groups: G (control), general anesthesia and systemic analgesia with dipyrone 1.2 g IM every 6 hours, and B (study), DNB regional anesthesia (axillary or supraclavicular) with 100 mg of bupivacaine and analgesia with the same local anesthetic every 6 hours. Clinical and metabolic alterations were correlated 24 hours postoperatively by clinical examination and capillary blood gasometry in both upper limbs. Results: most of the subjects studied were male and most of them aged 30-44 and 45-59 years in both groups (p = 0.05). Simple and multiple fractures accounted for 60% of the total sample in groups G and B respectively (p = 0.05) and emergency treatment was required in both groups (p = 0.05). 70 % of patients in group G felt the injured limb cold, and 13.3 % in group B (p = 0.01). A slow capillary refill was found in 53.3 % of patients in group G and 10 % in B (p = 0.01) and 56.7 and 10% patients in groups G and B (p = 0.01) showed pale hand respectively. HbO2 £ 89 % was found in the injured limb in 60 and 6.7 % patients in groups G and B respectively (p = 0.01), and a difference HbO2 > 5 % was corroborated among the upper limbs: 76.7 % patients in group G and 16.7 % in B (p = 0.01). Conclusions: the method of regional anesthesia-analgesia by continuous brachial plexus block is superior in terms of advantages, as there is a reduction in terms of changes in the metabolic clinical correlation in injured upper limbs.