A rare diagnosis has no certainty, but still they occur: A case report

Pain and swelling are among the most frequently encountered complaints in an orthopedics outpatient department (OPD) relatively less common in a pediatric OPD. A high level of suspicion is required to diagnose bone diseases. Common conditions such as rickets, septic arthritis, and tuberculosis must be ruled out. Treatment such as antibiotics, anti-inflammatory drugs, or steroids may mask an underlying serious condition in which if left untreated can cause significant morbidity and mortality to the person. Here, we discuss a case of a young infant 11 months of age who had symptoms suggestive of septic arthritis and was later found to have Brodie’s abscess which is a type of subacute osteomyelitis on further evaluation which is usually mistaken as a tumor. This age at presentation is rare.

Urinary tract infection with renal abscess

Renal abscess is very rare among intra-abdominal abscesses in children. Ascending infection is the most common cause in children compared to hematogenous spread in adults and Escherichia coli is the main pathogen. Persisting high-grade fever is an alarming sign to intervene and has to be taken care of. Here, we are presenting the case of a 3-year-old boy with Klebsiella urinary tract infection and E. coli renal abscess of 4 cm size. Contrast-enhanced computed tomography abdomen helped in early intervention and management. The child responded very well to parenteral antibiotics and ultrasound-guided percutaneous aspiration.

Changing Sleep Patterns and Anxiety due to Covid?19 Home Confinement among Working Population: A Cross?Sectional Study

Introduction: The COVID?19 pandemic took the entire world unawares and people were forced to stay indoors overnight. Due to this a drastic change ensued in lifestyle with many succumbing to various kinds of stresses and psychological problems. This study aims to study the changing sleep patterns and level of anxiety among the working population due to the COVID?19 Pandemic lockdown. Methodology: An online survey was conducted using a cloud?based website. The sleep patterns both prior to and during the lockdown period of the pandemic were assessed using a self?administered questionnaire. The level of anxiety during both these periods (before and during lockdown) amongst the working population was also assessed using the Generalized Anxiety Disorder Scores (GADS). Results: A total of 224 individuals participated in the study of which 52.7% were males and 47.3% were females. On analysis, the lifestyle and sleep deprivation scores showed that before the lockdown only 2.7% reported a low score out of total participants. However, this number was raised to 13.4% during the lockdown. The percentage of people reporting deteriorated sleep quality gradually increased with females reporting moderate to severe category of Generalized Anxiety Disorder scores as compared to Males. Conclusion: The study suggests that there has been a significant change in the sleep quality of the study participants due to Covid enforced lockdown which if unnoticed might lead to significant health problems. The effective use of programs like yoga, meditation, and deep breathing exercises, if followed timely could reduce psychological distress to some extent.

Hansen’s disease Like Sensory Loss Following Chikungunya Infection: A Rare Manifestation

Chikungunya means “that which bends up,” indicating severe incapacitating arthritis or polyarthralgia. It is a viral infection caused by the chikungunya virus (CHIK V) belonging to the family Togaviridae and is transmitted by the mosquitoes Aedes aegypti and Aedes albopictus. It is a self-limiting condition with a high fever of up to 40°C (104°F), debilitating arthritis/polyarthralgia, and cutaneous involvement. CHIK V virus affects the joints causing tenosynovitis and enthesopathy presenting as arthralgia. Leprosy is also associated with the loss of sensation, arthritis/arthralgias including involvement of several joints and tenosynovitis specially during reactions. Apart from leprosy, numerous other conditions can present with loss of sensation, which must be ruled out while considering leprosy. We report two patients with chikungunya who presented with a loss of sensation like leprosy

Evaluation of satisfaction and reasons for participation in a Covid-19 vaccine clinical trial: A single-centre, observational study

BACKGROUND In May 2020, WHO recognized the role of extensive immunization for interrupting the transmission of the SARS-CoV-2 virus. The development of such vaccines in clinical trials relies upon participants who are expected to be vested in the research process. Assessment of participant factors such as motivation and satisfaction are hence important to gauge perspective and ensure successful conduct and completion of these trials. METHODS We administered a validated three-domain questionnaire to and documented the binary categorical responses (yes/no) of participants (after informed consent) who had taken both doses of COVOVAX™ in a phase 3 trial at our institute. Association of the dependent variables (participant responses) with the independent variables (participant demographics and socioeconomic strata) was computed using Chi-square test at 5% significance. In case of a significant association, Bonferroni post-hoc test was applied for multiple comparisons. RESULTS Of the 78 participants who were administered the questionnaire, two-thirds were highly satisfied with their experience at our site. Gaining access to a new vaccine was a primary motivation overall (74%) and also in graduates (p=0.03) and middle-class population (p=0.002), whereas the lower-middle class population (p<0.0001) and those educated till secondary school (p=0.003) took part due to the long wait for government-approved vaccines. CONCLUSION Participants in a Covid-19 vaccine trial at Mumbai were largely satisfied with the care given to them though altruism did not feature as a primary reason for participation.

Does mismatch negativity have utility for NMDA receptor drug development in depression?

Rapid antidepressant effects associated with ketamine have shifted the landscape for the development of therapeutics to treat major depressive disorder (MDD) from a monoaminergic to glutamatergic model. Treatment with ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, may be effective, but has many non-glutamatergic targets, and clinical and logistical problems are potential challenges. These factors underscore the importance of manipulations of binding mechanics to produce antidepressant effects without concomitant clinical side effects. This will require identification of efficient biomarkers to monitor target engagement. The mismatch negativity (MMN) is a widely used electrophysiological signature linked to the activity of NMDA receptors (NMDAR) in humans and animals and validated in pre-clinical and clinical studies of ketamine. In this review, we explore the flexibility of the MMN and its capabilities for reliable use in drug development for NMDAR antagonists in MDD. We supplement this with findings from our own research with three distinct NMDAR antagonists. The research described illustrates that there are important distinctions between the mechanisms of NMDAR antagonism, which are further crystallized when considering the paradigm used to study the MMN. We conclude that the lack of standardized methodology currently prevents MMN from being ready for common use in drug discovery. Clinical trial registration: This manuscript describes data collected from the following National Institutes of Health (NIH) and Veterans Affairs (VA) studies: AV-101, NCT03583554; lanicemine, NCT03166501; ketamine, NCT02556606.

COVID-19 prediction models: a systematic literature review

As the world grapples with the problem of the coronavirus disease 2019 (COVID-19) pandemic and its devastating effects, scientific groups are working towards solutions to mitigate the effects of the virus. This paper aimed to collate information on COVID-19 prediction models. A systematic literature review is reported, based on a manual search of 1,196 papers published from January to December 2020. Various databases such as Google Scholar, Web of Science, and Scopus were searched. The search strategy was formulated and refined in terms of subject keywords, geographical purview, and time period according to a predefined protocol. Visualizations were created to present the data trends according to different parameters. The results of this systematic literature review show that the study findings are critically relevant for both healthcare managers and prediction model developers. Healthcare managers can choose the best prediction model output for their organization or process management. Meanwhile, prediction model developers and managers can identify the lacunae in their models and improve their data-driven approaches.

COVID-19 prediction models: a systematic literature review

As the world grapples with the problem of the coronavirus disease 2019 (COVID-19) pandemic and its devastating effects, scientific groups are working towards solutions to mitigate the effects of the virus. This paper aimed to collate information on COVID-19 prediction models. A systematic literature review is reported, based on a manual search of 1,196 papers published from January to December 2020. Various databases such as Google Scholar, Web of Science, and Scopus were searched. The search strategy was formulated and refined in terms of subject keywords, geographical purview, and time period according to a predefined protocol. Visualizations were created to present the data trends according to different parameters. The results of this systematic literature review show that the study findings are critically relevant for both healthcare managers and prediction model developers. Healthcare managers can choose the best prediction model output for their organization or process management. Meanwhile, prediction model developers and managers can identify the lacunae in their models and improve their data-driven approaches.

Successful Pregnancy in a Patient With Recurrent Pregnancy Loss Due to Afibrinogenemia Managed With Cryoprecipitate Prophylaxis in a Resource-limited Setting

@#Recurrent pregnancy loss (RPL) can be defined as loss of pregnancy on or before 20 weeks of gestation. About half of the cases, cause of recurrent miscarriage is unknown. Bleeding disorders induced miscarriage has to be thoroughly investigated for the sake of both mother and fetus. Here is an interesting case report of a 24-year-old patient who was diagnosed to have afibrinogenemia after three consecutive miscarriages. Fibrinogen level was 5 mg/dl with prolonged prothrombin time greater than 180 seconds and activated thromboplastin time greater than 180 seconds. We managed with periodic cryoprecipitate transfusion. Pregnancy course was uneventful and delivered a healthy female child at 34 weeks of gestation under supervision of multidisciplinary team. Here we are discussing the management and how we approached the case to have a successful pregnancy outcome.

Effect Of Combination Of Aqueous Leaf Extracts Of Psidium Guajava Linn And Moringa Oleifera Lam On Diabetes Mellitus

Objective: To determine the anti-diabetic activity of combined aqueous extracts (1:1mixture) of dry leaves of Psidium guajava linn and Moringa oleifera lam as well as to compare the anti-diabetic activity of these plants by in vitro methods. Methods: In vitro alpha amylase inhibitory assay was performed on porcine alpha amylase and the absorbance was measured at 540 nm using a microplate reader and glucose diffusion inhibitory assay using dialysis membrane. Acarbose was used as the standard in the above mentioned methods. Results: The mixture (1:1) of aqueous plant extracts (at a concentration of 100µg/ml) of Psidium guajava linn and Moringa oleifera lam exhibited 72.08333% inhibition with IC50 value of 10.9µg/ml. The leaf extracts of Psidium guajava (at a concentration 100µg/ml) exhibited 71.23288% of a α amylase inhibitory activity with an IC50 values 19.883µg/ml whereas the leaf extracts of Moringa oleifera (at a concentration of 100µg/ml) exhibited 70.58824% of α amylase inhibitory activity with an IC50 value of 27.974 µg/ml. The Acarbose (standard drug) at a concentration of 100µg/ml showed 72.09302% inhibitory effect on the α amylase activity with an IC50 value 8.9µg/ml. In glucose diffusion inhibition assay the mixture of plant extracts exhibited 76.57% inhibition at 150 min which produces more effects than the two plants. The aqueous extract of Psidium guajava leaves exhibited maximum glucose diffusion inhibition (75.32%) at 150 min as well as Moringa oleifera leaf extract showed the maximum inhibition of 73.70% at the same time interval. For acarbose the percentage was 82.74 at 150 min. The interpretation of the results was done by one-way anova method. Conclusion: The combined extract of the leaves of the 2 plants was found to be more effective than individual plant extracts against diabetes. On comparison of two plants Psidium guajava was found to be more active against diabetes than Moringa oleifera. Also the potentiation effect shown by the combination of extract may be due to synergistic effect of the phytochemical constituents. As the 1:1 mixture of the aqueous extract is found to be more active, the combination of the two plants can be used to formulate drugs for treating diabetes.

Depression and Anxiety among Patients undergoing Dialysis: An Observational Study

Introduction: Depression and anxiety are the most prevalentpsychological disorders among end-stage renal diseasepatients and are associated with various conditions that resultin poorer health outcomes, e.g. reduced quality of life andsurvival. Along with the psychological problems of patientsundergoing hemodialysis, sleep quality also plays a negativerole in patient health status. Frequent reports have documentedthat patients having complicated health and mental status maylead to poor health quality and may lead to mortality. Weaimed to investigate the prevalence of depression and anxietyamong patients undergoing renal dialysis therapy.Material and methods: A total of 95 patient’s data werecollected by using DASS questionnaire. DASS questionnairescores were evaluated, result was tabulated and interpreted.Scoring of questionnaire test is based on the a 0 – 3 scale whichindicates various range of depression, anxiety and stress scale.Results: Our study indicate that among 95 patients, manyof the patient having mild psychological problems includesdepression, anxiety and stress. Maximum range of 13.68%of patients have found out with anxiety and stress and nodepression state. But there were patients with no sign ofanxiety, stress and depression. Previous studies state thatpsychological variables include depression, stress, and,anxiety took part to get more health complications along withsleep disorders. But by providing right time health care andmental support, it is possible to get back patient health tonormal state. Our result concluded that none of the patient hasfound with complicated mental and health issues.Conclusion: Current study contributed that, among 95patient’s data analysis we have found out few number ofpatient with mild psychological abnormalities. But theseproblems did not reach to highly complicated state. So ourresearch study aimed to suggest nephrologists to aware ofthe quality of life in their patients and should consider thescreening of patients for various symptoms to improve thequality of life.

Sleeplessness in Patients with end-Stage Renal Disease Undergoing Dialysis Therapy in a Tertiary Care Center

Introduction: Maintenance dialysis patients experience a highburden of physical and emotional symptoms that directly affecttheir quality of life and health care utilization. Patient with endstage renal disease (ESRD), 80% of them have reported withcomplaints of subjective sleep abnormalities. Frequent reportshave documented in these patients such as sleep disturbancesmanifestation as insomnia, sleep apnea syndrome, restlessleg syndrome (RLS) periodic limb movement disorders, andexcessive day time sleepiness. Present study focused to findthe quality of sleep and sleep abnormalities in patients withESRD.Material and methods: Patient data were collected usingPittsburgh Sleep Quality Index(PSQI); The demographic andclinic questionnaire contained questions about age, gender,place of residence, dialysis frequency, HD (Haemodialysis)duration. Scoring of seven components answers is based ona 0 to 3 scale which reflects the various states of sleepingdisorders.Results: Study showed that during the earlier stage ofhemodialysis patients may have a high PSQI test score. In theperiod of 3- 12-month patients are facing poor sleep quality;indicating that in the earlier period of treatment patientsmay have taken more stress and conscious to adjust withhemodialysis as a routine treatment procedure for the rest ofthe life. This may instigate to have a high score in PSQI testscore.Conclusion: The current study indicates that RLS, poorquality sleep, and EDS are common in ESRD patients underhemodialysis. Additional studies involving the change ofhemodialysis shift may provide a better understanding ofthe correlation between time duration dialysis and sleepingdisturbances.

Correlation between QoTc and serum as well as ionised calcium in sick neonates

Background: Hypocalcemia is a frequently observed clinical and laboratory abnormality in neonates with risk factors such as prematurity, infant of diabetic mothers and perinatal asphyxia. Hypocalcemia can be asymptomatic or can cause apnoea, seizures, jitteriness, stridor, cardiac abnormalities. Clinically as calcium levels are maintained within narrow ranges. It is therefore imperative to measure and correct any deficit at the earliest. Unfortunately, total serum calcium level correlates poorly with ionized calcium level. Measurement of ionized calcium is both time consuming and expensive and therefore the need for more rapid, inexpensive and non-invasive method for screening at risk-neonates. Serum calcium levels are known to affect the duration of the QoTc interval. Therefore establishing a good correlation between serum/ionized calcium levels and QoTc will validate ECG as a reliable marker of hypocalcemia. Objective was to find correlation between QoTc interval and serum calcium levels in sick neonates.Methods: Total 730 infants were for serum total calcium and ionized calcium levels. Off these 142 infants with hypocalcemia, 29 infants were excluded based on exclusion criteria. The remaining 113 neonates were subjected to three cycles of ECG measurement before correction of calcium and were taken as cases. QoTc intervals were measured and were correlated with corresponding serum total calcium and ionized calcium levels.Results: In this study, a moderate negative or downhill correlation was found between total serum calcium QoT (r = -0.694 and p = <0.001) and QoTc (r = -0.680 and p = <0.001). The ionized calcium levels were found to have strong negative or downhill correlation with QoT (r = -0.837 and p = <0.001), QoTc (r = -0.819 and p = <0.001). All these correlations were found to be statistically significant with p<0.05.Conclusions: QoTc interval can be used as a surrogate marker for blood total or ionized calcium levels.

Predictors and Outcome of Severe Dengue Illness in Children.

Dengue fever has become a major public health concern during the last few years with an alarming increase in the incidence in 2017. The state of Kerala was one among the top of the list in India reported to have severe dengue infection. The two main districts in Kerala with high prevalence were Thiruvananthapuram and Palakkad, of which latter is the main referring area to our institution. This study was conducted to evaluate the clinical and demographic profile of children affected with dengue fever and determine the predictors of severity.METHODSThis is a hospital based prospective study done at the Department of Paediatrics, Government Medical College, Trissur, during the Monsoon season in 2017. Children diagnosed to have Dengue fever and confirmed by NS1 Ag test or IgM Elisa were included. Children were classified into 3 clinical groups and compared. Comparison was also made in 2 groups as dengue with warning signs and severe dengue as per WHO 2015 clinical guidelines, to find out the predictors of severity. Qualitative data was analysed and expressed in proportions and quantitative data in mean and standard deviation. Chi-square (χ2) test was used to evaluate the association between qualitative variables and ANOVA for quantitative variables. p value less than 0.05 was considered significant. SPSS 16.0 software was used for statistical analysis.RESULTSA total of 235 children were included. 77 children (32.9%) had mild dengue fever, 106 (45.29%) had DWS and 52 (22.22%) were having DSS). Mean age was 6.61± 3.497 years. 19 cases (8.2 %) were Infants below 1 year of age. Majority of children had normal nutritional status. Myalgia, tiredness, vomiting, diarrhoea, abdominal pain, flushing, bleeding, oedema, hypotension, were found to be the common clinical manifestations. Thrombocytopenia, elevated serum hepatic enzymes both SGOT and SGPT, abnormal renal function tests, low sodium, hypoalbuminemia, hypoglycaemia, abnormal radiological findings were found to be the predictors of severity. We had many cases of expanded dengue syndrome including 3 cases of Hemophagocytic lymphohistiocytosis (HLH). The mortality was 0.6%.CONCLUSIONSDengue fever can affect children irrespective of their age or nutritional status. Older children and male sex were found to be more affected. There are definite clinical and lab parameters which can predict the severity in Dengue fever. Though severe illness is associated with high morbidity early diagnosis and timely appropriate clinical management, correction of dehydration along with proper referral system can save the children. The mortality can be reduced to zero even in patients having expanded dengue syndrome and Dengue shock syndrome. None of the comorbidities had affected the outcome.

A Dual Genetic Alteration (Mitochondrial and Nuclear DNA): First Case in Malaysia Detected in Glioblastoma Multiforme

@#Although the precise etiology of Glioblastoma multiforme (GBM, WHO grade IV) remains unknown, its progression is believed to be driven by the accumulation of multiple genetic alterations. Here, we report a case of a patient who developed GBM, and associated with dual alterations, particularly 4977-bp deletion in mtDNA (mtDNA4977) and p.Arg132His (R132H) mutation in IDH1. A 35-year old Malaysian woman patient who primary diagnosed with astrocytoma WHO grade I and subsequently after four years developed a GBM, was detected with a mtDNA4977. This deletion appears to be a sporadic mutation. Additionally, analysis of patient’s tumor tissue also found to harbor a heterozygous IDH1 R132H mutation. This represents the first case report of coexisting mtDNA4977 together with IDH1 R132H mutation in a Malaysian patient of GBM. The findings of dual alterations could be of therapeutic benefit if these alterations were justified to be contributing to GBM growth and aggressiveness.

Cloning and sequencing of α-2u globulin of rat preputial gland to assess its longevity in the context of developing an effective rodent trap

α-2u globulin, a pheromone binding protein found majorly in the preputial gland, was reported to involve in chemo-communication of rats. The biosynthesis of this pheromone binding protein is under complex multihormonal control and its regulation takes place at transcription level. Assessing and increasing the longevity of this protein may retain the volatility of pheromone. So far nearly 20 isoforms of α-2u globulin in rat have been studied. The present study was aimed to extend the longevity of pheromone compound by cloning and sequencing of the mRNA which codes for α-2u globulin in the preputial gland of Rattus novergicus. Unexpectedly, this study resulted in a new isoform, which is similar in function with α-2u globulin protein with some different exons removed. Further analysis with this isoform may pave a way for rodent pest management.

Study on risk factors of respiratory distress syndrome in term neonates: a retrospective case-control study

Background: Respiratory distress syndrome (RDS) is one of the most common causes of neonatal respiratory failure and neonatal death. It is more common in preterm neonates but also been found in term and late preterm neonates. This study aims at studying the risk' factors for developing RDS in term neonates. Objectives was to study the maternal and perinatal risk factors for RDS in term neonates.Methods: This is a retrospective case control study conducted in neonatal intensive care unit of tertiary care centre. A total of 100 term neonates with RDS were taken as cases and 150 normal term neonates were taken as control. Data were collected from the hospital NICU records, maternal and neonatal history was taken. The ?2 tests or Fisher's exact text were used for one-way risk factor analysis. The effects of multiple factors on term neonatal RDS were analyzed using logistic regression analysis.Results: In our study RDS in term neonates' was significantly associated with following risk factors like selective cesarean section, male sex, SGA, oligohydramnios, MSAF, severe fetal distress, birth asphyxia, PROM, and maternal-fetal infection. Among the significant risk factors severe birth asphyxia, maternal-fetal infection, PROM, MSAF were showing positive association with RDS in full-term neonates.Conclusions: Several high-risk factors such as severe birth asphyxia, maternal-fetal infection, PROM, and MSAF were closely correlated with full-term neonatal RDS. Hence these could provide a significant reference for the diagnosis and treatment of term neonatal RDS.

Volume guarantee ventilation in premature neonates with respiratory distress: a comparative study

Background: Respiratory distress syndrome (RDS) occurs in about 50% of preterm infants born at less than 30 weeks of gestational age. Surfactant therapy and mechanical ventilation have been the standard of care in the management of RDS. Objective of this study to compare the time required to achieve successful extubation criteria in Volume guarantee mode of ventilation to that with Time cycled pressure-limited mode of ventilation and the duration of mechanical ventilation between them in preterm neonates ventilated for respiratory distress syndrome.Method: The study was done at Neonatal intensive care unit, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala over a period of 2 years. Total of 37 inborn preterm neonates between 26 weeks to 32weeks with RDS requiring mechanical ventilation were included in 2-year study period with 18 babies in 1st year study period ventilated with SIPPV mode and 19 babies in 2nd year study period on SIPPV'VG mode of ventilation. Analysis was done using SPSS v. 16 software.Results: In the present study the neonates receiving SIPPV-VG ventilation had stable and equivalent gas exchange at significantly lower MAP and PIP compared to neonates receiving SIPPV -TCPL. Also, neonates receiving SIPPV-VG had achieved significantly faster extubation criteria than SIPPV-TCPL and hence lesser duration of ventilation.Conclusion: Our study concludes that Volume Guarantee ventilation achieves near stable tidal volume delivery by auto-weaning peak inspiratory pressures thereby promoting early extubation and hence reducing volutrauma and barotrauma in contrast to TCPL mode.

Study on electrolyte disturbances in dengue fever in a tertiary care centre

Background: Dengue is a mosquito borne disease of significant morbidity and mortality. Dengue viral infection has been shown to be associated with electrolyte abnormalities and renal dysfunction. It is necessary to have a thorough understanding about electrolyte disturbances in Dengue, so as to predict, diagnose and treat them accordingly. The aim and objective of this study is to study electrolyte disturbances in dengue fever and its correlation with severity of dengue fever.Methods: This study was performed in a tertiary care centre in Bangalore , India. The study was a prosspective observational study. 200 Patients diagnosed with Dengue were enrolled for the study. Patients demographic data, clinical history, electrolyte values were recorded and analysed.Results: In our study majority of patients belonged to 5-12 years age group ie 47%. Fever was found to be the most common presentation in 196 patients (98%) followed by myalgia in 142 patients (71%), headache in 102 patients (51%), skin rash in 43 patients (21.5%). The mean value of serum sodium observed was 133.69 mEq/L and of serum potassium was 3.58 mEq/L and there was positive and significant correlation between difference in serum sodium and potassium levels with severity of dengue fever.Conclusions: Dyselectrolytemia is more common in dengue fever. Serum electrolytes testing early is very important in dengue patients during management so that if abnormalities are found, they can be appropriately managed as some of these abnormalities may lead to increased severity as well as mortality.