To study the effect of 'Covishield' vaccination on pre-donation platelet counts of plateletpheresis donors

ABSTRACT Introduction: Approximately 55.52% of the Indian population had been fully vaccinated by Jan. 2022, since its first roll out on January 16, 2021. A few concerns were raised concerning the Covishield vaccination related to thrombotic thrombocytopenia. Apheresis-derived platelet concentrates are frequently required in a plethora of clinical situations and post-vaccination decrement of platelet counts might lead to increased deferral of the plateletpheresis donors. Objectives. The aim of the study was to discover the effect of the Covishield vaccination on deferral rates of plateletpheresis donors. Methods: Blood samples were collected from the potential platelet donors for the completion of the standard questionnaire for the complete blood count. The data collected were tabulated in the MS Excel spreadsheet and the biostatistical analysis was performed with the SPSS v23. A p-value of < 0.05 was taken as significant. We compared this data with age-and sex-matched controls. Results: The mean age of cases and controls was 29.69 ± 8.57 and 30.15 ± 7.11, respectively. There was a significant difference in platelet counts of cases (188496.35 ± 72065.66/cumm) and controls (269524.50 ± 53981.60/cumm). Furthermore, donors who received one dose had higher platelet counts of 248676.47 ± 80075.24/cumm than those who received both doses of vaccine (179970.83 ± 66773.73/cumm). The difference in deferral rates between the two groups was remarkable (34.7% vs. 0.9%, with the p-value < 0.001). Conclusion: Vaccination certainly increased the deferral rates of plateletpheresis donors due to low platelet counts. Average platelet counts were low in fully vaccinated individuals, however, the platelets returned to normal counts as the post-vaccination days progressed.

Left paratesticular mass mimicking polyorchidism: A case report

We report a rare case of primary scrotal lipoma in a 20-year-old patient which clinically mimics a left triorchidism. The patients presented with the left testicular swelling and the ultrasonography of the scrotum revealed an inhomogeneous hyperechoic mass with an inconclusive report. The left scrotal hemi exploration was planned, and intraoperatively, it was found to be a paratesticular mass with an equivalent size corresponding to the left testicle, separate from the left testicle. The histopathology confirms the lipomatous swelling. The post-operative period remains uneventful and the patient has been on follow-up for the past 1 year with no relapse

Placental expression of striatin & endothelial nitric oxide synthase in women with & without pre-eclampsia

Background & objectives: Striatin is a multi-domain scaffolding protein essential for activating endothelial nitric oxide synthase (eNOS). However, its role in pre-eclampsia remains use explored. Hence, this study aimed to investigate the association between striatin and eNOS in regulating nitric oxide (NO) production in the placenta of women with and without pre-eclampsia. Methods: Forty pregnant women each without (controls) and with pre-eclampsia (cases) were enrolled in the study. Blood striatin and NO concentrations were detected by the ELISA. Protein expression of striatin, phosphorylated eNOS (peNOS), inducible NOS (iNOS) and phosphorylated NF-?B were measured in the placental tissues by Western blot. Twenty four hour urinary protein and serum urea, uric acid and creatinine were analyzed as an autoanalyzer. Placental histology was analyzed by haematoxylin and eosin staining. Results: Compared to normotensive pregnant women, the levels of serum NO and striatin were decreased in pre-eclamptic women. The protein expression of striatin and peNOS was significantly reduced (P<0.05) while p65NF-?B and iNOS were upregulated considerably (P<0.05) in the placenta of cases compared to controls. Interpretation & conclusions: Our results show for the first time that decreased striatin expression was associated with decreased peNOS protein expression in the placental tissue of pre-eclamptic women. Interestingly, no significant difference was found in blood striatin or NO levels between controls and cases. Thus, therapies that improve placental striatin expression are attractive possibilities, both for prevention as well as treatment of endothelial dysfunction in pre-eclampsia.

Identifying the Potential Determinants of Tobacco Counseling Implementation among Oral Health Professionals of India: A Cross-Sectional Survey

ABSTRACT Objective: To identify the potential determinants of tobacco counseling implementation among oral health professionals in India. Material and Methods: A cross-sectional survey was carried out among the 298 dentists of Aligarh and Gwalior. The questionnaire used in the study had sections on dentists' sociodemographic data and a 35-item questionnaire to assess the potential determinants of tobacco cessation counseling. Descriptive statistics were carried out, and a Chi-square test was utilized to determine the association. P-value <0.05 was considered statistically significant. Results: Domains "knowledge", "Professional Responsibility and Identity", and "Remembrance, awareness, and judgment" showed a statistically significant correlation with most tobacco cessation counseling behaviors. In addition, undergraduate education received in Tobacco Cessation counseling, and Continuing education received in Tobacco Cessation counseling had significantly impacted the practice of tobacco cessation counseling (p=0.02 and 0.04, respectively). Conclusion: This study suggests that "Knowledge", "Professional Responsibility and Identity" and "Remembrance, awareness, and judgment" are the potential determinants that could be used to design effective strategies to enhance tobacco counseling among dentists in India.

Clinical spectrum of elderly-onset inflammatory bowel disease in India

Background/Aims@#Inflammatory bowel disease (IBD) is increasingly being recognized in elderly patients. Data on clinical spectrum of elderly-onset IBD patients is lacking from India. @*Methods@#A cross-sectional retrospective analysis of a prospectively maintained database of patients diagnosed with IBD was conducted at 2 centers in India. The clinical spectrum of elderly-onset IBD including demographic profile (age and sex), clinical presentation, disease characteristics (disease behavior and severity, extent of disease), and treatment were recorded and compared with adult-onset IBD. @*Results@#During the study period, 3,922 (3,172 ulcerative colitis [UC] and 750 Crohn’s disease [CD]) patients with IBD were recorded in the database. A total of 186 patients (4.74%; 116 males [62.36%]) had elderly-onset IBD (69.35% UC and 30.64% CD). Diarrhea, blood in stools, nocturnal frequency and pain abdomen were the commonest presentations for UC, whereas pain abdomen, weight loss and diarrhea were the most frequent symptoms in CD. For both elderly onset UC and CD, majority of the patients had moderately severe disease. Left-sided colitis was the commonest disease location in UC. Isolated ileal disease and inflammatory behavior were the most common disease location and behavior, respectively in CD. 5-Aminosalicylates were the commonest prescribed drug for both elderly onset UC and CD. Thiopurines and biologics were used infrequently. Prevalence of colorectal cancer was higher in elderly onset IBD. @*Conclusions@#Elderly onset IBD is not uncommon in India. Both the elderly onset UC and CD were milder, with no significant differences in disease characteristics (disease extent, location and behavior) when compared to adult-onset IBD. Colorectal cancer was more common in elderly onset IBD.

A Study on Clinical Profile of Hemifacial Spasm in India and the Therapeutic Response to Botulinum Toxin Type A Injection as well as Pre and Postinjection Quality of Life

Background: Hemifacial spasm (HFS) is a distressing, involuntary, irregular tonic-clonic contraction of the facial muscles innervated by the seventh cranial nerve. It affects the quality of life. Botulinum toxin is a preferred symptomatic treatment option for the condition. However, there is a lack of study in the Indian scenario. Therefore, we observed the demographic profile, clinical spectrum, therapeutic response, and adverse effects of botulinum toxin and assessed the quality of life in the pre and postinjection phases in our subjects with HFS. Materials and methods: The study design is a prospective open-label observational study. Consecutive cases of HFS were selected from the general neurology outpatient department (OPD) and movement disorder clinic of a medical college hospital in Eastern India. Clinical and relevant neuroimaging studies excluded mimickers and secondary causes of HFS. Institutional Ethics Committee’s permission was obtained. Informed consent was taken from patients before botulinum toxin injection. The pre and postinjection assessment tools were spasm rate for a specific period of time, quantification of facial asymmetry, widening palpebral fissure by visual analog scale, Jankovic disability rating scale, HFS-7 scale, and videography. Results: A total of 250 cases of HFS (F:M = 138:112) were studied. The mean age of presentation was 47 years. The mean dose of botulinum toxin injection was 24.2 units per patient. The mean duration of improvement was 4 months. The spasm frequency was decreased by 90%, and the facial asymmetry was improved by 86%. The improvement in quality of life was 86%. Local adverse effects are seen in 10.4% of cases, and all were reversible. Conclusion: This is one of the largest studies on the effects of botulinum toxin in subjects with HFS in the Indian population. Periodic injection of botulinum toxin is a safe and effective therapy for subjects with HFS. There is a significant improvement in the quality of life following botulinum toxin therapy in subjects with HFS. Adverse effects were local, mild, well-tolerated, and reversible.

The aging larynx: An anatomical perspective

There has been a striking increase in the geriatric population worldwide over the last few decades. As the aging process continues to alter functioning of all body systems, the human voice is also significantly affected. The senile voice is characterized by its changes in pitch, hoarseness, tremulousness, and breathiness with reduced harmonics and intensity. Such phonatory changes in the elderly may hinder effective communication, thus bringing down their confidence levels and impairing their quality of life. These characteristic features that distinguish the senile voice from younger speakers are accompanied by age?related changes in the organ of phonation, the larynx. The summative morphological and structural changes occurring in the elderly larynx have been referred to as “Presbylarynx.” The present review article is an attempt by the authors to explore the various anatomical age-related changes occurring in the larynx that may be responsible for altered vocal function in the elderly. An improved understanding of the anatomical basis of the aged voice can give further directions into the management of vocal disorders and improved speech performance in the elderly.

Physiochemical response of papaya genotypes exposed to low temperature regimes

Susceptibility to low temperature stress is the major threat to papaya cultivation. Here, we studied a low temperature stress tolerance in papaya plant. We have investigated the effect of different low temperature regimes, 28°/18°C (day/night) to 16°/06°C (day/night) with a gradual decrease of 2°C on every two days and one set with direct exposure to the low temperature of 18°/08°C (day/night), called the acclimatized plant, in five diverse papaya genotypes (Pusa Nanha, Red Lady P-7-2, P-7-9, and P-7-14) and cold tolerant wild relative of cultivated papaya genotype (Vasconcellea cundinamarcensis V.M. Badillo) under controlled regulated conditions. It was observed that there were significant variations in the physiological and biochemical parameters like photosynthetic gas exchange parameters, chlorophyll content, fluorescence parameters, relative water content (RWC), membrane stability index (MSI), total sugars content, total soluble proteins content, lipid peroxidation, and proline accumulation in leaf tissues. Maximum stomatal conductance, chlorophyll fluorescence, RWC, MSI, total sugars, total soluble proteins, proline and lowest MDA contents were observed in Vasconcellea cundinamarcensis followed by inbred P-7-9 as compared to other genotypes under low temperature stress. Among all the papaya genotypes, P-7-9 showed more adaptability to low temperature stress and it further give new insights for developing low temperature tolerant papaya genotypes, especially under changing climate situations.

CLINICAL AND CYTOGENETICS ANALYSIS OF WOMEN THAT WERE SUSPECTED FOR TURNER SYNDROME IDENTIFIED AS 19.8% CHROMOSOMALABNORMALITY IN NORTH INDIAN POPULATION

Purpose: The objective of present study was to know the contribution of different types chromosomal anomalies in manifestation of Turner syndrome. Turner syndrome is a chromosomal disorder mainly due to growth retardation and primary amenorrhoea. Cytogenetic analysis of cases referred for Turner syndrome is necessary for an early diagnosis which helps in genetic counselling to manage it in a better way. Total 237 cases suspected for Methods: Turner syndrome, were included in this study for duration of 7 years (2007-2014). We implemented the standard protocol for peripheral whole blood lymphocyte culture, chromosome preparation followed by G-banding. Chromosomes were analysed according to the guidelines of International System for Human Cytogenetic Nomenclature (2005). After analysing 237 Results: registered cases, chromosomal anomalies were seen only in 47 cases (19.8%). Careful clinical examination of patients with abnormal karyotype (n=47) revealed four major phenotypes i.e. growth retardation (n=19, 40.4%), primary amenorrhoea (n=19, 40.4%), primary amenorrhoea with growth retardation (n=6, 12.8%), and oligoamenorrhoea (n=3, 6.4%). Seven different types of chromosomal abnormalities were observed viz. Monosomy X (n=22, 46.8%), triple X syndrome (n=2, 4.2%), turner mosaic (n=3, 6.4%), ring chromosome (n=5, 10.6%), structural abnormalities with X chromosome (n=6, 12.8%), mosaic structural X abnormality (n=1, 2.1%), XY gonadal dysgenesis (n=8, 17%). This study revealed the frequency of Conclusion: most common clinical phenotype and different chromosomal abnormalities in patients suspected for turner syndrome. We observed growth retardation and primary amenorrhoea as most common clinical feature and monosomy of X chromosome as most frequent chromosomal abnormality in this cohort of study.

Evaluation of biphasic hydroxapatite and ?-tricalcium phosphate as a bone graft material in the treatment of periodontal vertical bony defects – A clinical and digital radiological measurement study

Aims and Objective: The present study aimed to evaluate 2 bone graft materials, that is, biphasic hydroxyapatite and ??tricalcium phosphate, in the treatment of periodontal vertical bony defects. In term of attachment level, probing depth and radiographic bone level changes. Also, a new digital method of radiographic assessment was used for measurement of vertical bone defect. Material and Methods: Ten subjects with periodontitis and having two or more vertical bony defects were enrolled in the study. Patients were classified randomly into 2 groups. Group I consisted of the experimental site where defect was filled with biphasic hydroxyapatite and ??tricalcium phosphate graft and Group II consisted of control site where only the open flap debridement (OFD) was carried out. Clinical parameters were evaluated at baseline, 3 and 6 months; Radiographs were taken at baseline and 6 months after surgery. Results: Overall, by the end of 6 months, biphasic hydroxyapatite and ??tricalcium phosphate and OFD treatment groups exhibited a significant reduction in probing depth almost by 75% and gain in clinical attachment level at follow?up. In the biphasic hydroxyapatite and ??tricalcium phosphate group, radiographic bone level gain appeared to be greater than in the OFD group. Conclusion: In the present study, biphasic hydroxyapatite and ??tricalcium phosphate have shown promising results and have showed reduction in probing depth, a resolution of osseous defects and gain in clinical attachment level when compared to open flap debridement.

Plastination Technique and Its Impact on Medical Education

Introduction:Plastination has been one of the most effective preservative methods for organic tissue during the last four decades. In this technique, water and lipid content present within biological tissue samples are substituted by polymers (silicone, epoxy, pol yester), resulting in dry, durable, and odourless specimens. Plastinated specimens are now used as teaching tools and various medical disciplines, such as anatomy, pathology, radiology, surgery, and so on across the world. Since its development by Gunther von Hagens in 1977, plastination is getting increasing acceptance by the day and proving itself to be an excellent resource material for both teaching and learning. This review highlights the origin, procedure, types, significance, and drawbacks of plastination along with its ethical aspects.

Entrepreneurial Intention: A Critical Review

Economic experts all over the world have regarded Entrepreneurship as the fourth factor, next to land, labour and capital; for the production of goods as well as services. Entrepreneurs are said to be the steering wheel for the economic development of a Nation. The contributions of an Entrepreneur for the Country as a whole and the society in particular is enormous. In this context, it is important to study about Entrepreneurship and explore in detail about its significance. This paper aims to draw special attention to the importance of Entrepreneurship. Further, the need of Entrepreneurial Intention and its scope taking students into consideration has also been highlighted.

Study of Municipal Solid Waste Management in Ranchi, Jharkhand

Solid waste management (SWM) have becomes a very serious concern globally. The lack of individual responsibilities as well as proper attitude and approach leads to this issue. Rapid industrialization, increase in population and further increase in standard of living and poor waste management have increased the serous health issue. In India we generate about one 1 lakh ton of MSW per day. Almost every ton of MSW is disposed of unscientifically. Though the compostable organic waste ranges between 34-70 percent, improper segregation or no segregation at source has challenged the further treatment and disposal experiments. Ranchi city need to be taken care by various new SWM techniques, proper management skill and adequate care the diseases and improve medical conditions. This paper deals with the proper description of the current MSWM process and the real time scenario where every individual is a source of waste creation. The effect of growing population of last ten years outcome of waste quality and quantity generated throughout these years have been discussed. It is observed that more than 4000 tons of waste per month is being generated. Researches shows that the disposal of solid waste requires 2,700,000 m2 area for the land up to the year 2030. Far sustainable development and effective management it is suggested that implementation of newer technologies, training of common people, and effective implementation of government policies will help to come out of these current issues

Ophthalmology practice in COVID-19 pandemic: Performance of rapid antigen test versus real time-reverse transcription polymerase chain reaction in a tertiary eye care institute in South India

Purpose: To assess the rapid antigen test (RAT) against the gold standard reverse transcription?polymerase chain reaction (RT?PCR) to screen COVID?19 infection in asymptomatic patients undergoing ophthalmic procedures. Methods: This was a retrospective hospital?based study. Point?of?care (PoC) RAT was performed using nasopharyngeal swab, while RT?PCR for SARS?CoV?2 viral RNA was performed using both nasopharyngeal and throat swabs. Results: A total of 629 patients were tested for SARS?CoV?2 by using both RAT and RT?PCR. Only one patient had tested positive for SARS?CoV?2 with both RAT and RT?PCR, while two patients had tested positive with RT?PCR after an initial negative RAT. The positivity rate for RAT was 0.15% (1/629), and that for RT?PCR was 0.47%. Percent agreement or proportion of agreement observed between the two tests was 99.68%, while Cohen’s kappa coefficient value was 0.49. The sensitivity of RAT in comparison to RT?PCR was 33.33%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 99.68%. Conclusion: The sensitivity and Cohen’s kappa coefficient in our study were low but that can be attributed to the overall low positivity rates with both RAT and RT?PCR. However, percent agreement observed between the two tests was very high. Therefore, we recommend initial screening of all the patients for COVID?19 symptoms followed by RAT before performing any ophthalmic surgical procedure to ensure the safety of the health care professionals as well as the patients.

Iatrogenic Isolated Ruptured Dorsalis Pedis Artery Pseudo Aneurysm : A Rare Case Report

A Dorsalis Pedis Artery (DPA) pseudo aneurysm is one of the most uncommon peripheral arterial aneurysms. These aneurysms can cause distal embolization and thrombosis, leading to limb loss. However, their rupture is unusual1. Any type of injury or perhaps an iatrogenic intervention can cause a pseudo localized swelling of the dorsalis pedis artery, which is a relatively unusual condition. Whenever it presents as a non-pulsatile soft tissue mass in the presence or absence of a specific predeceasing event, it can lead to a difficult diagnostic dilemma2. The rare instance of an iatrogenic pseudo aneurysm of the dorsalis pedis artery which mimicked cellulitis of the right foot is discussed in this case report. Coil embolization of the proximal artery, and the aneurysm was successfully done by the intervention radiologist. After the procedure, collateral circulation was maintained. No ischemic symptoms such as intermittent claudication or pain at rest were observed. This approach may be useful in treating similar cases

International Council of Ophthalmology-Small Incision Cataract Surgery rubric: A roadmap to evaluate cataract surgical skill acquisition during residency training

Purpose: The International Council of Ophthalmology?Small Incision Cataract Surgery (ICO?SICS) rubric is a tool to grade SICS steps from novice to competent. The study aimed to evaluate the progress of residents’ surgical skills by using the ICO?SICS rubric and the perceptions of residents and faculties about its use. Methods: This prospective educational interventional study, done in the Ophthalmology department between September 2019 and February?2020 included 14 residents and five faculties. Faculties scored residents’ SICS by ICO?SICS?rubric (four sessions/resident) and helped them identify three steps as “area of focus” to work upon. Feedback was taken using a semi?structured pretested questionnaire. Focus group discussion was done for residents. Data were entered in MS Excel and analyzed using SPSS. Perception analysis presented as percentage of written responses. Results: Step?wise rubric score showed improvement for initial SICS steps and wound closure (P < 0.05). Critical surgical steps and scores for three areas of focus steps showed no statistically significant improvement. Three steps as an area of focus changed partly for 11 residents and completely for three residents at the end of 6 months. Perception analysis of faculty and residents showed that the ICO?SICS rubric is a good tool to record surgical performance, identify steps needing improvement and provide structured feedback hence opined to continue it. Residents considered it as an effective learning and assessment tool. Conclusion: ICO?SICS rubric is a good teaching tool and helps to assess the progress of surgical skills. Identification of areas of poor performance and feedback given motivates them to focus on those areas leading to continuous professional development, resulting in competent surgeons performing SICS surgery independently at the end of the residency

Molecular Characterization and Management of Congenital Hyperinsulinism: A Tertiary Centre Experience

Background: There is limited data from India regarding medical management of congenital hyperinsulinism (CHI). Objective: To study the molecular diagnosis, medical management and outcomes of children with CHI. Study design: Ambispective. Participants: Children with CHI admitted in from December, 2011 till March, 2020 at a tertiary care referral hospital. Outcomes: Clinical and genetic profile, treatment, and response Results: 42 children with a median age of 3 days (range 1 day to 6 years) were enrolled, of which 23 (54.7%) were diazoxideresponsive. Mutations were identified in 28 out of 41 (68.2%) patients. The commonest gene affected was ABCC8 in 22 patients. The pathogenic variant c.331G>A in ABCC8 gene was identified in 6 unrelated cases from one community. Good response to daily octreotide was seen in 13 of the 19 (68.4%) diazoxide-unresponsive patients. Monthly long-acting octreotide was initiated and daily octreotide could be stopped or tapered in 9 patients. Sirolimus was tried with variable response in 6 patients but was discontinued in 5 due to adverse effects. Four patients had focal CHI, of which one underwent partial pancreatic resection. The disease severity reduced with age and neurodevelopment was good in the patients with identifiable genetic defects who were optimally managed. Conclusions: Medical management of CHI is effective, if compliance can be ensured, with good quality of life and neurological outcomes.

Clinical profile, visual outcome and root cause analysis of post-operative cluster endophthalmitis due to Burkholderia cepacia complex

Purpose: To present varied clinical presentations, surveillance reports, and final visual outcomes of a rare outbreak of cluster endophthalmitis caused by gram?negative, opportunistic bacilli, Burkholderia cepacia complex (Bcc). Methods: Details of five patients who developed postoperative cluster endophthalmitis were collected. For each patient, an undiluted vitreous sample was collected during vitreous tap. Bacterial culture from the vitreous sample in each case had grown Bcc. Surveillance investigations for root cause analysis (RCA) were performed in the operating room (OR), admission, and day?care wards to localize the source. Results: Four patients had undergone phacoemulsification surgery, and one patient had undergone penetrating keratoplasty. Each patient received an initial dose of empiric intravitreal ceftazidime and vancomycin. The organism isolated in each case was sensitive to ceftazidime, cotrimoxazole, and meropenem and resistant to other antibiotics. Core vitrectomy was done after 48–60 hours in four patients along with intravitreal imipenem injection. One patient did not provide consent for core vitrectomy and subsequently developed phthisis bulbi. Three patients had subsequent recurrences. Two patients had a final BCVA of 20/60, two had BCVA better than 20/200, while one patient had no perception of light. None of the surveillance samples from the OR complex could isolate Burkholderia. Conclusion: Extensive OR surveillance should be done to identify the potential source of infection. However, the source may not be identifiable in few instances like in our case. Longer follow?up is recommended in cases of Bcc endophthalmitis due to the persistent nature of the infection

Use of thiopurines in inflammatory bowel disease: an update

Inflammatory bowel disease (IBD), once considered a disease of the Western hemisphere, has emerged as a global disease. As the disease prevalence is on a steady rise, management of IBD has come under the spotlight. 5-Aminosalicylates, corticosteroids, immunosuppressive agents and biologics are the backbone of treatment of IBD. With the advent of biologics and small molecules, the need for surgery and hospitalization has decreased. However, economic viability and acceptability is an important determinant of local prescription patterns. Nearly one-third of the patients in West receive biologics as the first/initial therapy. The scenario is different in developing countries where biologics are used only in a small proportion of patients with IBD. Increased risk of reactivation of tuberculosis and high cost of the therapy are limitations to their use. Thiopurines hence become critical for optimal management of patients with IBD in these regions. However, approximately one-third of patients are intolerant or develop adverse effects with their use. This has led to suboptimal use of thiopurines in clinical practice. This review article discusses the clinical aspects of thiopurine use in patients with IBD with the aim of optimizing their use to full therapeutic potential.