Clay ingestion induced hypokalemic paralysis: a rare case report in an elderly female with severe iron deficiency anemia

Hypokalemic paralysis is a rare neuromuscular disorder characterized by painless muscle weakness resulting from low potassium levels, most commonly presenting during adolescence. In this case report, we detail the presentation and management of an 80-year-old female who experienced sudden onset bilateral limb weakness. Initial clinical assessment revealed the absence of reflexes and hypotonia in all four limbs without any gastrointestinal or neurological symptoms. Comprehensive diagnostic evaluation identified severe iron deficiency anemia and an unusual history of clay ingestion due to pica as the underlying causes of her hypokalemic paralysis. Treatment included intravenous and oral potassium supplementation, as well as packed cell volume transfusions, leading to a significant improvement in her symptoms and normalization of her potassium levels. This case highlights the need to consider atypical etiologies, such as pica-induced clay ingestion, in the differential diagnosis of hypokalemic paralysis, particularly in elderly patients with nutritional deficiencies. Early recognition and appropriate management are critical for favourable outcomes.

Sowing Time and Spacing Influenced Yield, Quality and Economics of Bt Cotton (Gossypium hirsutum L.)

A field study was conducted in the 2019 kharif season at the Agronomy Instructional Farm, SDAU, SKNagar, Gujarat, India. To investigate that the sowing time and spacing influenced yield, quality and economics of Bt cotton (Gossypium hirsutum L.) in loamy sand soil. Twelve treatment combinations were examined, involving three sowing times (T1: 3rd week of May, T2: 1st week of June, T3: 3rd week of June) and four plant spacings (S1: 90 cm × 60 cm, S2: 90 cm × 45 cm, S3: 60 cm × 60 cm, S4: 60 cm × 45 cm). Four replications of a split plot design were used for the experiment. The third week of May was consistently the best time to sow cotton, according to the results, producing the maximum yields of seed cotton and stalk cotton. The quantity of monopodial branches/plant, harvest index and plant population as well as quality parameters such as oil content and ginning percentage were not significantly impacted by sowing time. The 3rd week of May sowing also yielded the highest benefit cost ratio and net realization. In terms of plant spacing, the spacing of 60 cm × 45 cm promoted highest plant population, taller plants and increased yield attributes like the bolls/plant, boll weight and seed cotton yield/plant. The highest seed cotton yield and stalk yield were achieved with this spacing. Harvest index and quality parameters were unaffected by plant spacing. The narrow spacing of 60 cm × 45 cm also resulted in the highest benefit cost ratio and net realization. The interaction effect between sowing time and plant spacing did not significantly influence growth, yield, yield attributes and quality parameters of Bt cotton.

Heart rate variability in patients presenting with anginal symptoms in absence of cardiac and other diseases

Objectives: Angina is a symptom of coronary artery disease (CAD). Modulation of cardiac autonomic tone as assessed by heart rate (HR) variability (HRV) is found reduced in patients with CAD; myocardial ischemia, myocardial infarction and some other cardiovascular diseases. Reduced HRV has been found associated with sudden cardiac death in these CAD patients. Several patients present with anginal symptoms clinically in absence of CAD or other diseases. The status of HRV is not much clear in these patients. Thus, we aimed to assess HRV in patients with angina with and without myocardial ischemia and compare it with HRV of healthy subjects of similar age groups and follow-up patients for 1 year for cardiac/health events. Materials and Methods: The study included 61 consecutive male patients clinically presenting with angina and 30 healthy subjects. Based on Thallium-201 myocardial perfusion Single-photon emission computerized tomography (SPECT) imaging, patients were divided into two groups; patients with myocardial perfusion defects (MPD), (n = 33, age 54.91 ± 7.43 years) and patients with no MPD (NMPD), NMPD (n = 28, age 53.04 ± 8.50 years). Short-term HRV was assessed in all patients and subjects in resting supine position following standard protocol. All MPD and 25 NMPD patients could be followed up for 1 year for cardiac/health events. Results: Surprisingly, the NMPD patients showed significantly reduced HRV, Standard deviation of the N-N intervals, The square root of the mean squared differences of successive N-N intervals, Percentage of the number of interval differences of successive N-N intervals greater than >50 ms divided by total number of R-R intervals, low frequency (LF) power, High Frequency (HF) power and total power as compared to both MPD patients and healthy subjects. (Total power [NMPD vs. MPD]: 610.1 [379.9–1072.8] vs. 1508.0 [748.4–2339.4] millisecond squares (ms2 ), P = 0.001), healthy subjects (Total power: 1414.6 [1104.6-2141.5] ms2 , P = 0.001). The markers of sympathetic tone; LF (normalised unit) and LF/HF ratio were higher in NMPD patients as compared to MPD patients resulting in an altered sympathovagal balance. During a 1-year follow-up, sudden death was seen in one MPD patient (3.1%) and two NMPD patients (8%). Conclusion: The NMPD patients showed significantly reduced HRV as compared to both MPD patients and Healthy subjects with an altered sympathovagal balance. Sudden death was also seen in NMPD patients as MPD patients.

Analysis Of Completeness Of Blood Vacuume Tube Filling At A Clinical Laboratory Attached To Tertiary Care Center, A Cross Sectional Study

Background:Overfilled and under filled tube are most important cause of pre-analytical error and failure to complete requested examination in sample. The study was performed to analyse relationship betweentime of receiving of sample, location of sample, type of vacuum tube, method of collection, total volume required in a patient and volume incompleteness.Material And Methods:The study involved collection and patient samples data, i.e. receiving time of sample, place of collection, type of vacuum tube, blood collection method, total volume required in a patient, measurement of volume before processing. Average incompleteness of vacuum tube was calculated and average relationship between incompleteness and these parameters done.Result:Average incompleteness in OPD samples is better than Non-OPD samples. Averageincompleteness is better during 9 am to 12 am than early morning hour s. Incompleteness with relation to vacuum tube type is in general Plain > (EDTA/Fluoride) > Citrate. Average incompleteness better in sample collected with vacuum tube needle with holder than use of syringe. Average incompleteness increases as total volume required in a patient increases.Conclusion:Dedicated phlebotomist and use of vacuum tube needle with holder is required to bring overall improvement in completeness of blood collection.

Analyzing The Role Of Phytochemicals In Targeting Drug Transporter Protein Abcc6 Using Molecular Docking And Molecular Dynamics Simulations

Triple negative breast cancer (TNBC) is an aggressive breast cancer subtype that lacks hormonal receptors. This reduces the therapeutic options for TNBC patients creating more focus on chemotherapy. Drug resistance has posed as a major hurdle in treating TNBC patients. Deregulation of drug transporter proteins is one of major factors that cause resistance to chemotherapeutic drugs. In this study, ABCC6 a drug transporter protein that is found dysregulated in several resistant cancer cells has been docked with natural compounds or phytochemicals with known anti-cancer activities. Subtrifloralactone G, a withanolide extracted from Deprea subtriflora is found to show highest binding energy with ABCC6 protein. Molecular dynamics simulations further prove the stability of the ABCC6 protein- Subtrifloralactone G ligand complex. ADMET analysis shows that phytochemical Subtrifloralactone G can be used as an anti-cancer therapeutic drug in treating resistant cancer cells. The study mainly focuses on the role of phytochemicals in treating resistant TNBC cells.

A View on Combination Antiplatelet Agents in Ischemic Stroke.

The evaluation of antiplatelet agents for prevention of ischemic stroke is being focused as a strategy for stroke reduction. The aim of this analysis was to focus specifically on the necessity of combination antiplatelet agents for secondary prevention of ischemic strokes. Aspirin, clopidogrel, ticlopidine and the combination of aspirin plus extended-release dipyridamole are all effective in reducing the risk of recurrent ischemic strokes and transient ischemic attack. Furthermore, the combinations of all above drugs show some merits and demerits in one or more condition. National guideline endorses any of these antiplatelet agents as appropriate treatment options but more research into this strategy is needed. Choosing a single antiplatelet agent or the combination must be tailored according to patient characteristics, cost, disease condition and tolerability. Other classes of antiplatelet drugs should undergo clinical trials to optimize antiplatelet therapy.

The Development of an Instrument to Measure Women's Experience of an Aerobic Dance Class

The purpose of the study was to pilot an instrument to measure women's experience in an aerobic dance class with regard to their descriptions of the general atmosphere; the music; the dance moves and routines; and the instructor. In addition; the participants were asked to rate a list of exercise benefits in order of personal importance. A sample of 27 women; ranging in age from 25 to 60 years participated in this pilot study. The women responded with positive endorsements for all aspects of the overall dance experience; but their most affirming descriptions revolved around the instructor. There was an almost unanimous agreement amongst the participants about the importance of the instructor's role in their experience of the class. Their responses to the open ? ended questions supported these sentiments. The mental and physical benefits were rated as important for most of the women whilst a much lower percentage rated the social benefit as important. Two items in the semantic differential posed problems but the instrument showed promise in eliciting key aspects of women's experience in an aerobics dance class

The centrality of community dynamics in the socio-economic recovery of devastated communities / El carácter central de la dinámica de la comunidad en la recuperación socio-económica de las comunidades devastadas

OBJECTIVE: To assess and explore the health and socio-economic outcomes of Jubilee, a community on the Caribbean island of Grenada hit by Hurricane Ivan in 2004 and to identify remaining barriers to recovery. METHODS: The assessment consisted of a mixed methods approach employing observations, household surveys, in-depth interviews and focus groups. RESULTS: Eighty-five per cent of the residents live in a single-family home type dwelling which is occupied by multiple families. Twenty-seven per cent of the respondents depended on a river or stream for water and 83% utilized an outdoor pit latrine. Construction accounted for 28% of the employment while 16% reported having no occupation. Public and private transportation was limited and 48% of the residents lived on less than one United States of America (US) dollar per day. Access to healthcare was reported by 89% and the prevalence of diabetes and hypertension was identified by 13% and 30% of the residents respectively. Social fragmentation within the community represents a barrier that keeps the community from developing common goals leading to full economic recovery. CONCLUSION: Jubilee has not fully recovered from the effects of Hurricane Ivan, but progress has been made in the reconstruction effort. These efforts have addressed the most immediate and basic needs of the community, mainly utility service infrastructure and home repairs. However, issues related to the community's economic recovery are still unresolved.

OBJETIVO: Evaluar y explorar la salud y los resultados socio-económicos de Jubilee, una comunidad de la isla caribeña de Granada, afectada por el huracán Iván en el 2004, e identificar los obstáculos que aún quedan para la recuperación. MÉTODOS: La evaluación consistió en un abordaje de métodos mezclados que empleaban la observación, encuestas domésticas, entrevistas detalladas, y grupos focales (grupos de discusión). RESULTADOS: El ochenta y cinco por ciento de los residentes viven en viviendas que son para una sola familia, pero están ocupadas por familias múltiples. El veinte por ciento de los encuestados dependían de un río o una corriente para obtener agua, y un 83% utilizaba letrinas de pozo exteriores. La construcción daba cuenta del 28% de los empleos, en tanto que el 16% reportó no tener ocupación. Tanto el transporte público como el privado se hallaban limitados, y el 48% de los residentes vivían con menos de un dólar americano (1 USD) por día. Acceso a la atención a la salud fue reportado por 89% y la prevalencia de la diabetes y la hipertensión fue identificada por el 13% y el 30% de los residentes, respectivamente. La fragmentación social dentro de la comunidad representa un obstáculo que impide que la comunidad desarrolle metas comunes, que conduzcan a una plena recuperación económica. CONCLUSIÓN: Jubilee no se ha recuperado totalmente de los efectos del huracán Iván, pero ha habido progreso en los esfuerzos por la reconstrucción. Estos esfuerzos han estado dirigidos a las necesidades básicas y más inmediatas de la comunidad, fundamentalmente a la reparación de las casas y las infraestructuras de servicios. Sin embargo, los problemas relacionados con la recuperación económica de la comunidad siguen aún sin solución.

Preliminary Validation of the Multi-Attitude Suicide Tendency (MAST) Scale Using a South African Adolescent Sample

Objective:The factor structure of the Multi-Attitude Suicide Tendency (MAST) scale was examined using a sample of non-white South African adolescents. Method: The MAST scale was administered to 205 secondary school students between 13 and 20 years of age. Results: The scale demonstrated satisfactory internal consistency with alpha values being in line with previous studies using the instrument. Factor analysis confirmed the original four-factor structure of the scale. Strong support was found for the Repulsion by Death (RD) and Attraction to Life (AL) subscales of the instrument; with moderate support for the Atttraction to Death (AD) and Repulsion by Life (RL) subscales. Conclusion: The authors conclude that the generalisability of the MAST can be improved by the inclusion of more culturally relevant items

Role of skeletal scintigraphy in soft tissue sarcoma: Improving the diagnostic yield.

BACKGROUND: The presence of skeletal metastases significantly influences the therapeutic strategy adopted for soft tissue sarcoma. However, literature on the prevalence of skeletal metastases in soft tissue sarcoma is limited and none of the available data is based on the Indian patient population. AIM: To determine the prevalence of skeletal metastases at presentation in patients of soft tissue sarcoma and to rationalise the use of preoperative skeletal scintigraphy in such patients. METHODS AND MATERIAL: Preoperative bone scans were evaluated in 122 patients with soft tissue sarcoma (median age, 34 years; range, 4-83). The scans were classified into 3 grades: Grade 1: metastases very likely; Grade 2: equivocal; Grade 3: normal or benign lesion. In all the patients studied, the ability of the patient to localize the site or sites of pain was recorded and that was correlated with the site of metastases in scintigraphy. RESULT: Seventeen (13.9%) patients had Grade 1 scan; 16 of them had bony pain that was not readily explainable by trauma or other local factors. Ten ( 8.1%) patients had Grade 2 scan, five of them had bony pain which was not readily explainable by trauma or other local factors. Ninety-five patients (77.8%) had Grade 3 scan. Of these, 9 had localised bone pain which could be definitely associated with trauma or joint degeneration. CONCLUSION: The prevalence of skeletal metastases at presentation in patients with soft tissue sarcoma is low (13.9%). The low rates of skeletal metastases in bone pain-free patients (0.9%) versus the high rate in symptomatic patients (76.1%) supports the use of bone scanning in symptomatic patients only.

Biotransformation of banana waste into protein by pleurotus sajor-caju.

Pseudostems and leaves from banana waste were used for biotransformation into protein by using P. sajor-caju, an oyster mushroom. Treatment of formalin (500 ppm) + carbendazim (12.5 ppm) of these substrates was found to favour relatively high percentage biological efficiency (BE) of P. sajor-caju.. Steam sterilization also exhibited comparable yield performance by P. sajor-caju. Fruiting bodies harvested from all the treatments had relatively higher protein contents. The spent substrate (steam sterilized) was found to be suitable as an ideal animal feed because of its rich nutritive composition.

Experience with the pectoralis major myocutaneous flap for head and neck reconstruction in a general surgical unit.

The pectoralis major myocutaneous (PMMC) flap or its modification was used in 19 cases after resectional surgery for malignancy of the oral cavity with minimal morbidity and no mortality. The resection as well as reconstruction was done by the same team consisting only of general surgeons. The final functional and cosmetic results were satisfactory. The pectoralis major myocutaneous flap is a hardy flap and can be performed with relative ease even by those not specialised in plastic surgery. This makes it an important tool for a general surgeon practicing in a country like India with its high incidence of head and neck malignancy.

Obstructed Morgagni's hernia (a case report).

A forty-year-old male patient was admitted with acute intestinal obstruction, plain X-ray abdomen and chest revealing air fluid levels on the right side of chest. A successful operation was carried out and the patient made an uneventful recovery. Obstructed Morgagni's Hernia is an uncommon case and hence the presentation.

Development stage-specific expression of fibroin in the silk worm Bombyx mori is regulated translationally.

The contents of fibroin H RNA as a function of development have been quantitated in the posterior silk glands of Bombyx mori larvae on different days of 4th and 5th instars. The fibroin RNA levels increased during the feeding stages of larvae and the RNA got completely degraded during the interim moult. The patterns of accumulation of fibroin RNA were similar in both the instars. Although there was considerable increase in the fibroin RNA content during the 5th larval instar, the relative abundance of fibroin RNA in the total RNA was fairly constant during the 4th and 5th instars. The increased content of fibroin RNA in 5th instar was the consequence of an overall increase in transcription accompanying the development progress, rather than specific increase only in fibroin transcription. The contents of fibroin protein in the 4th and 5th instars of development have also been quantitated making use of a sensitive radioimmune assay with a purified, antifibroin antibody. There were substantial differences between 4th and 5th instars in the absolute fibroin contents as well as the relative proportion of fibroin in the total proteins. These results implied that although the fibroin gene was transcribed at the same efficiency during the 4th and 5th instars, the translational efficiency was much lower during the 4th instar. The extent of polyadenylation of fibroin RNA was similar in both instars. However, there was a two-fold increase in the polysome association of fibroin RNA in the 5th instar. Over and above this, there was substantial increase during the 5th instar in the contents of those tRNAs. (e.g. Gly, Ala and Ser) which are abundantly represented in fibroin and therefore directly related to the expression of fibroin. The increased polysome association of fibroin mRNA and the adequate supply of cognate tRNAs in the 5th instar, together contributes to the translational regulation of fibroin in a developmental stage-specific manner. Based on these observations, we propose that translational regulation plays a major role in the development stage-specific synthesis of fibroin in Bombyx mori.

Actinomycotic pseudo-tumour of the mid-cervical region (a case report).

Cervicofacial actinomycosis is today a rare disease in our country. Isolated actinomycotic neck masses are extremely rare. A case of young man with an isolated midcervical tumour like actinomycotic granuloma without sinuses or discharging granules is reported here.