Hirayama Disease: A Rare Case Report and Review

Hirayama disease, or brachial monomelic amyotrophy, is not a common neurological disease characterized by unilateral or asymmetric bilateral lower motor weakness of distal upper limbs. The basic pathophysiology is compression of the dural sac and spinal cord during flexion of the neck. A case of a 21-year-old male presented with chief complaints of tremors in both hands (right more than left) with gradually progressive weakness of the right hand and forearm. Electromyography (EMG), nerve conduction velocity (NCV), and magnetic resonance imaging (MRI) neck in flexion showed focal atrophy of lower cervical myotomes and confirmed the diagnosis of monomelic amyotrophy.

Iron Deficiency Anemia as a Potential Risk Factor for Unprovoked DVT in Young Patients: A Case Series

Deep vein thrombosis (DVT) is a serious and potentially life-threatening condition due to the occurrence of pulmonary embolism (PEs) in the acute phase. DVT can be provoked or unprovoked. Provoked DVT can be associated with transient or persistent causes. Iron deficiency anemia (IDA) with reactive thrombocytosis can act as a prothrombotic condition. We present two case reports of lower limb DVT which was associated with moderate anemia. Association between IDA and thrombosis has been reviewed.

Antimicrobial photocatalysis using bio-hydrothermally synthesized Zinc oxide nanoparticles in the management of periodontitis: a prospective split-mouth, double-blind, randomized, controlled clinical trial

Abstract The antimicrobial activity of metallic nanoparticles (NPs) has been confirmed to fight a broad spectrum of microorganisms, through antimicrobial effects that are amplified when these particles are irradiated with light of the proper wavelength. This is the first study to use phytoconjugated Zinc oxide (ZnO) NPs containing traces of active biomolecules derived from Emblica officinalis (E. officinalis) plant extract in antimicrobial photocatalysis (PCT) during non-surgical periodontal therapy. Objectives This study aimed to evaluate the effects of repeated PCT application in the treatment of periodontitis, using a gel containing bio-hydrothermally synthesized ZnO NPs and visible light as an adjunct to scaling and root planing (SRP). Methodology In total, 16 systemically healthy volunteers with stage 3 grade B generalized periodontitis were recruited for this prospective double blind, randomized placebo-controlled trial. After receiving SRP, the subjects received the following interventions in a split-mouth design at baseline, 1 week and 1 month: Group 1 - Placebo gel + Sham PCT; Group 2 - Nano ZnO gel + Sham PCT; Group 3 - Placebo gel + PCT; and Group 4 - Nano ZnO gel + PCT. The site-specific profile of Porphyromonas gingivalis in the subgingival plaque and clinical parameters (Plaque Index, Gingival Index, Gingival Bleeding Index, Probing pocket Depth and Clinical Attachment Level) were assessed at baseline, 1 month and 3 months. Results All interventions tested caused participants' clinical and microbiological parameters to generally improve after 3 months. Subjects who received the Nano ZnO gel + PCT combination showed a sustained and progressive improvement in their treatment outcomes, a result that presented statistically significant differences from the outcomes obtained through the remaining interventions, at all time points during the study period. Conclusions The repeated application of PCT using bio-hydrothermally synthesized ZnO NPs can effectively complement SRP in the non-surgical treatment of Periodontitis.

Probable Mode of Action of Panktiprasoonadi Ghritham in Vishaja Vrana Based on Analysis of Rasa Panchaka of Ingredients

Traditional management of Visha Chikitsa involves many practices that are yet to be explored. Keraleeya Visha Chikitsa Granthas possess abundant knowledge of practically used formulations in treatment of Visha as well as its complications. Vishaja Vrana can be considered as Aganthuja Vrana which has to be managed at time to prevent its complications. Vrana hara Yogas with specific indication will be working more effectively in this condition. Visha Jyotsnika, a book written in Malayalam which explains about the treatment practices followed by Visha Vaidyas from time to time in a practicable approach. Mandali Visha Chikitsa is explained in sixth chapter in detail along with various Vranahara yogas. This article highlights about the probable mode of action of Panktiprasoonadi ghritham in Vishaja Vrana. Dasa Pushpa, the divya aushadhi for Visha being the main ingredient in this formulation along with the combination of other Vrana Ropana drugs like Kupilu, Haridra, Yastimadhu, Sariva etc as a Ghrita preparation will be an excellent option for managing Vishaja Vrana from its initial condition.

Knowledge, Attitude and Practice of generic medicines- an explorative study among Interns of a Tertiary care teaching hospital of Central Karnataka

Background: Health care related expenditure is increasing with a rapid pace in which much proportion of expenses is on medicines. The expenditure can be reduced by prescribing generic medicines (Janaushadi). In India less prescription of generic medicines can be correlated to less knowledge. Hence this study was carried out among Interns who will be future practitioners to know their perception and practice about generic medicines. Objectives: To assess the Knowledge, Attitude and practice of Interns regarding generic medicines. Methodology: A cross sectional study was carried out among Interns using a pre-tested semi structured questionnaire containing questions related to their Knowledge, Attitude and their practice regarding generic medicines. Data was entered in MS Excel and analysed using SPSS version 20. Descriptive statistics were used. Results: Among the study participants, majority (90%) knew the correct meaning of the generic medicine. 97% of them felt that generic medicines can be prescribed instead of branded medicines. Majority (92%) of the study subjects felt that there should be one Janaushadi (generic medicines) store at every government hospital. Not many (19%) were aware of the law in India for prescribing generic medicines but majority (87%) knew about the Janaushadi Scheme of Government of India. 87% of the Interns had prescribed generic medicines to patients and among them they (85%) felt that generic medicines are easy to prescribe than branded medicines. Conclusion: This study showed that the Interns have good perception regarding generic medicines. Minor proportion of the study participants knew about the law in India for prescribing generic medicines. Majority of the participants have prescribed generic medicines to patients and felt that it is easy to prescribe generic medicines.

Consensus guidelines on management of oral potentially malignant disorders

Oral cancer is usually preceded by oral potentially malignant disorders (OPMDs) and early detection can downstage the disease. The majority of OPMDs are asymptomatic in early stages and can be detected on routine oral examination. Though only a proportion of OPMDs may transform to oral squamous cell carcinoma (OSCC), they may serve as a surrogate clinical lesion to identify individuals at risk of developing OSCC. Currently, there is a scarcity of scientific evidence on specific interventions and management of OPMDs and there is no consensus regarding their management. A consensus meeting with a panel of experts was convened to frame guidelines for clinical practices and recommendations for management strategies for OPMDs. A review of literature from medical databases was conducted to provide the best possible evidence and provide recommendations in management of OPMDs

Titanium Elastic Nailing in Pediatric Femoral Shaft Fracture: A Study of 40 cases at NITOR, Bangladesh

Background: The Titanium Elastic Nail is mostly used in children to treat diaphyseal and metaphyseal fractures. The age of the patient, as well as the nature and location of the fracture, determine if the TEN is necessary. In some situations of femoral diaphyseal fractures, it is a successful and realistic therapeutic choice. The TEN allows for elastically stable intramedullary nailing. In terms of patient and parent happiness, as well as shorter confinement to bed and hospital stay, open reduction can produce a significantly better outcome than traction and spica cast or any other treatment. The aim of the study was to observe Titanium Elastic Nailing for treatment of femoral shaft fractures.Material & Methods:This observational study was conducted at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Bangladesh. The study duration was 2 years and 8 months, from April 2019 to December 2021. The study was conducted with a total of 40 cases of femoral shaft fracture in pediatric patients who were admitted to the study hospital.Results:Male prevalence was observed in the present study, with 3.44:1 male: female ratio. Mean±SD age of the participants was 8.8 ± 1.6 years, and sports injuries were the most common cause of fractures. 72.5% of the participants were aged between 5-10 years, and the age range of the participants was 5-13 years. 50% of the participants had fractures at the middle region of the femur, while 45% had fractures at the proximal region. Mean±SD hospital stay duration was 14.5 ± 2.4 days, with 62.58% having hospital stay between 7-14 days. Majority of the participants of the present study faced no complications, while 20% had <1.0 cm of leg length inequality, 2.5% had 1-2 cm leg length inequality, 2.5% faced infection, 5% faced entry site irritation and 1 patient had soft tissue irritation by prominent nail. At 12-monthg follow up, 75% had excellent outcomes while 20% had satisfactory outcomes.Conclusions:The titanium elastic nailing is an effective and viable treatment option in selected cases of femoral shaft fractures in the 5-13 years’ age group. Even if it is done by open reduction it gives much better result than traction & Spica cast or any other methods, in respect to patient & parent’s satisfaction & shorter confinement to bed & hospital stay.

Effectiveness of physiotherapy treatment on functional capacity in post covid-19 survival subjects.

Introduction: In late December 2019, an outbreak of a highly contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) started from the city of Wuhan, China. A high proportion of individuals who recovered from the acute phase of COVID-19 including SARS and MERS reported persistence of fatigue. Rehabilitation of post-COVID-19 patients is crucial for recovering from fatigue and improving functional status. Need for the study (brief): There are currently scarcity reports on the physiotherapy of COVID-19 patients that focus on fatigue, grip strength and endurance and their overall contribution to improve functional capacity. OurStudy Methodology (brief): study design focussed on randomized controlled trial. We took sample size of 30, based on various inclusion and exclusion criteria.We included only those patients for our test who were a) non-critical and had tested positive for SARS- COV 2 virus based on RT-PCR test (Nasopharyngeal and Oropharyngeal swabs). These patients were admitted to COVID wards however not admitted in ICU. b) Recovered Patient who were referred either by physician or pulmonologist for post-covid rehabilitation (post 14/17 days of quarantine).We excluded those patients from our studies a) who refused to give their consent b) who had neurological deficits c) who were unable to ambulate/with any lower limb disability or fractures d) who were haemodynamically unstable. We segregated our subjects into two categories either experimental group or control group based on sequential envelope method. Our analysis for the data is based on statistical software R version 4.1.1 and Microsoft Excel. We have used Shapiro-Wilk's test to check the normality of variables and Paired t- test/Wilcoxon's test to compare the mean/distributions of pre-operative and post-operative parameters. The ethical clearance was obtained from SDM institutional ethical committee. We had done the CLINICAL REGISTRATION TRIAL with the CTRI reference number is REF/2021/07/045807. Finally derived from the study highlighted the roleconclusion of physiotherapy intervention in not just improving the endurance and fatigue in covid 19 patients but also helped in reducing the complications and helped the patients to carry out their ADLS much more efficiently and helped in improving their quality of life.

Haemophilia management programme: Transformation during COVID-19

Background & objectives: Haemophilia is a debilitating bleeding disorder with significant comorbidities affecting the quality of life. In India, the management of these individuals is still limited to on-demand institutional treatment with coagulant factors. In this study, we highlighted the problems faced by these patients in the COVID-19 period due to nationwide lockdown. Methods: A retrospective study was done to ascertain the trend in the number of patients with haemophilia A and B visiting the hospital, those succumbing to haemophilic complications and indications for factor requirement in the pre-COVID (October 2019-March 2020) and during the COVID-19 period (April-September 2020). Representative cases with unusual complications were described along with significant challenges faced in providing standard care of treatment to these individuals due to the COVID-19 pandemic. Results: A total of 818 and 162 individuals with haemophilia A and B, respectively, were registered with the department. The overall number of patient visits to the hospital significantly reduced from an average of 6.9 outpatient department (OPD) visits per patient in the pre-COVID-19 period to an average of 3.9 OPD visits per patient and admissions reduced to 50 per cent during the COVID-19 period. This led to a reduction in utilization of factors VIII and IX except VIIa for haemophilia with inhibitors. There was no factor utilization for elective surgeries during the COVID-19 period. A total of eight patients succumbed to haemophilia-related complications during the COVID-19 period due to delay in reaching the hospital. The challenges faced in the management of three cases with musculoskeletal bleeds, one case with scrotal haematoma and one with haemothorax during the COVID-19 period were also highlighted. Interpretation & conclusions: COVID-19 pandemic has unveiled the need for on-demand home treatment with coagulant factors and has also brought to light the existing need for primary prophylaxis, especially for younger individuals with haemophilia.

Congenital Hyperinsulinemia of Infancy: Role of Molecular Testing in Management and Genetic Counseling

Congenital hyperinsulinemia (CHI) is a genetically and clinically heterogenous disorder. In addition to the standard care of management of the proband, genetic counseling regarding the risk of recurrence in the future siblings is an important part in the management of the disorder. The counseling needs identifcation of accurate etiology and is challenging due to the complexity of the molecular mechanisms of CHI. This case highlights the importance of molecular testing which not only helped in planning the management of the proband with CHI but also helped in providing genetic counseling for which the family had consulted the medical genetics department.

PERSONAL EFFECTIVENESS PROFILE OF PHYSICAL EDUCATION STUDENTS IN MANGALORE UNIVERSITY AND ALVAS COLLEGE OF PHYSICAL EDUCATION MOODBIDIRE

The study 124 physical education trainees studying in Mangalore University and Alva's College of Physical Education Moodbidri. the procedure adopted for the selection of subjects, construction and development of Questionnaire, Selection of variable, administration of Questionnaire and collection of data, and Statistical treatment of data or described. Methodologies that have been used in research on teaching effectiveness were the perfect teaching method, process-product and mediating-process designs, and ecology mode. The result indicate that as a whole the majority of Physical Education trainees in Mangalore University are ineffective .when it comes to comparison Alva's College of Physical Education College trainees have lower hand in terms of ineffectiveness .

A proposed scoring system for fast triage of COVID 19 patients using basic clinical parameters: Simple Clinical Parameter (SCIP) Score

Introduction : Globally healthcare systems are jeopardized due to the COVID-19 pandemic. A fast and simple triage is very important for effec?ve u?liza?on of health care resources. We propose a new tool is for severity assessment of pa?ents at the ini?al point of care. Objec?ve: To propose a scoring method for fast triage of COVID 19 pa?ents in predic?ng the level of care required by the pa?ent Methods: The SCIP score is for pa?ents who have been tested posi?ve for COVID-19. This scoring system is useful to segregate the pa?ents into different level of care based on values of clinical parameters like Pulse rate (PR), Respiratory rate (RR) and arterial blood oxygen satura?on. The risk score ranges from 1 to 10. Lower the score more severe is the disease and hence more intense care is warranted. Result: Preliminary observa?on of SCIP scoring criteria is based on ten pa?ents. On retrospec?ve analysis it was observed that the level of care required by the pa?ents was in correspondence with the score obtained by the SCIP formula. Conclusion: SCIP scoring system is an easy and rapid tool which may be helpful in early detec?on of severity and taking fast decision in the ?me of crisis due to COVID 19. Valida?on in more number of pa?ents is required to establish the findings.

Prevalence, Risk Factors, and Prescribing Trends in Chronic Renal Failure in the Indian Population

Objective: To estimate the prevalence of Chronic renal failure (CRF) in the Indian subcontinent and to identify risk factors and treatment regimens for CRF. Methods: A prospective observational study was carried out for 7 months. A total of 200 patients with a level of creatinine >1.5 mg/dl were enrolled. CRF prevalence was measured using the hospital’s inpatient department registry and medical records. The risk factors and prescribing were evaluated from the patient file report. Results: The prevalence rate of CRF was 13.7%. Male patients (59%) dominate the entire group of patients. Most patients (n = 52) were found between the age group of 71–80 years with a mean age of 62.67 ± 16.33 years. Drugs such as diuretics, and hypoglycemics were indicated to treat comorbidities. The average number of drugs per prescription were 7.43 ± 2.75 with high use of antimicrobial agents (88%). Out of 156 drugs prescribed, 76 were from essential as per essential Drug List 2017. Hypertension (P = 0.0072) and diabetes (P = 0.0084) were major concerns as risk factors followed by the drugs used for dyslipidemia, and recurrent infections. Conclusion: The prevalence rate was found to be 13.7% with significant association with risk factors such as hypertension, diabetes, and nonsteroidal anti-inflammatory drugs, dyslipidemia, chronic infections, smoking, and renal calculus for CRF. The pattern of prescribing was suitable and with few irrationalities.

Pancreatic tuberculosis: An unusual presentation

Tuberculosis (TB) of pancreas is a rare presentation in both immune-competent and immune-suppressed patients. Its presenting clinical features are usually vague and non-specific, while radiological features mimic other common pancreatic conditions such as malignancy, so it is often misdiagnosed. It commonly involves the head and the uncinate process of the pancreas. We report a middle-aged immune-compromised man who presented with left-sided tubercular pleural effusion and later was diagnosed as pancreatitis by clinical presentation and TB of pancreas on computed tomography of the abdomen.

Comparison of Relative Loudness Judgment in Children using Listening Devices with Typically Developing Children

Abstract Introduction Loudness perception is considered important for the perception of emotions, relative distance and stress patterns. However, certain digital hearing devices worn by those with hearing impairment may affect their loudness perception. This could happen in devices that have compression circuits to make loud sounds soft and soft sounds loud. These devices could hamper children from gaining knowledge about loudness of acoustical signals. Objective To compare relative loudness judgment of children using listening devices with age-matched typically developing children. Methods The relative loudness judgment of sounds created by day-to-day objects were evaluated on 60 children (20 normal-hearing, 20 hearing aid users, & 20 cochlear implant users), utilizing a standard group comparison design. Using a two-alternate forced-choice technique, the children were required to select picturized sound sources that were louder. Results The majority of the participants obtained good scores and poorer scores were mainly obtained by children using cochlear implants. The cochlear implant users obtained significantly lower scores than the normal-hearing participants. However, the scores were not significantly different between the normal-hearing children and the hearing aid users as well as between the two groups with hearing impairment. Conclusion Thus, despite loudness being altered by listening devices, children using non-linear hearing aids or cochlear implants are able to develop relative loudness judgment for acoustic stimuli. However, loudness growth for electrical stimuli needs to be studied.

Age Estimation by Modified Demirjian's Method in a Hospital-Based Population: A Radiographic Study

ABSTRACT Objective: To test the modified Demirjian's method of dental age estimation on the South Indian population and correlate it with the patient's chronological age. Material and Methods: This retrospective radiographic study was performed on digital panoramic radiographs taken during a one-year duration. Radiographs of patients in the age range from 8 to 18 years were included in the study. The radiographs were examined and according to the stage of the crown and root status of the left side mandibular teeth. The stage of calcification was observed for eight teeth in the mandibular arch and was recorded in a specially designed proforma. Each rated tooth with stage was converted into a score using a conversion table specified for girls and boys. Results: 224 digital panoramic radiographs were retrieved from the radiologic database. Out of total study sample, 49.5% (n=111) were boys and 50.5% (n=113). The mean chronological and estimated dental age using dental maturity scores resulted in an overestimation of 3 years and eight months. Also, it was noted that there was a strong positive association between chronological (real) and dental age. Conclusion: It was observed that there was a strong correlation between chronological and dental age. A new formula for determining the chronological age from the estimated dental age was derived. Further studies on a larger population may prove the reliability of this age estimation method.

Gangliocytic paraganglioma of the spine

Paragangliomas are rare, encapsulated, benign neuroendocrine tumors that can arise from the adrenal medulla or extra-adrenal paraganglia. Extra-adrenal paragangliomas may develop a gangliocytic component with ganglion cells (Gangliocytic paragangliomas). Nearly 25%of cauda equina paragangliomas are gangliocytic paragangliomas. Here, we describe the case of a 35-year-old male who presented with weakness of both lower limbs over the last two months. Radiological findings were suggestive of myxopapillary ependymoma. However, the histopathological examination revealed a tumor with cells arranged in sheets, papillae, lobules, and around vessels forming pseudo rosettes. Ganglion cells were seen in small groups and, also singly. Tumor cells were immunopositive for chromogranin, synaptophysin, and S-100. Ganglion cells were immunopositive for synaptophysin, NSE, and NFP. A final histological diagnosis of Gangliocytic paraganglioma (WHO grade I) was made. To date, only nine gangliocytic paraganglioma cases have been previously reported, and to the best of our knowledge, this is the largest gangliocytic paraganglioma.

Ureteric endometriosis masquerading as ureteric neoplasm

Endometriosis is a disease seen in 10-15% of reproductive age women, which involves the pelvic cavity. The urinary tract is affected in 1% cases of pelvic endometriosis, while 0.1-0.4% of ureteric endometriosis which is extremely rare. Ureteric endometriosis poses a diagnostic challenge, as it can be asymptomatic or can present as renal colic. It can lead to a severe burden on kidneys like hydroureteronephrosis, renal atrophy, and irreversible renal failure. Authors report an extremely rare case of ureteric endometriosis in a postmenopausal female, who presented with complaints of lower backache. Radiologically diagnosed as neoplastic ureteric stricture.