Role of therapeutic plasma exchange as a desensitization therapy in human leukocyte antigen incompatible renal transplant patients: A single-center experience

Abstract Objective Despite an increase in the rate of successful live donor renal transplantation done annually, the number of potential recipients with acceptable donors is relegated to the ever-expanding cadaver-donor waiting list due to sensitization to human leukocyte antigen (HLA) antibodies. If not sufficiently suppressed, these preformed HLA antibodies can trigger antimicrobial resistance (AMR) and early graft loss. To ameliorate this situation, various desensitization treatments are administered to provide a survival benefit to highly sensitized patients. Method One hundred and six patients in the time frame of January 2017 to March 2019 were included in the study group. The desensitization protocol included therapeutic plasma exchange and administration of low-dose intravenous immunoglobulin (100 mg/kg per therapeutic plasma exchange (TPE) session) to highly sensitized patients (treatment group) who subsequently underwent renal transplantation after negative pre-transplant Centers for Disease Control and Prevention Luminex crossmatch (CDC/LumXM). We compared graft survival rates between the group undergoing desensitization (treatment group) and matched control group of patients that underwent HLA-compatible transplantation. Results In the treatment group, Kaplan-Meier analysis estimates an average rate of patient graft survival of 95.2% at 3 years post-transplant, as compared with the rate of 86.9% in the same time frame for the control-matched group (p < 0.05 for both comparisons). Conclusion Desensitization treatment with TPE before live donor renal transplantation in the case of patients with HLA sensitization provides better survival benefits along with monitoring for donor-specific antibodies (DSAs) and other infections, rather than waiting for a compatible organ donor. The data lays out evidence that desensitization treatments can assist overcome HLA incompatibility barriers in live donor renal transplantation.

Rare vulvar lesions: A case series

@#Mass of the vulva include both benign and malignant lesions. Benign mass lesions of the vulva include tumors, hamartomas, cysts, infectious disorders, and non-neoplastic epithelial disorders. Some are rare mass lesions. Here, we presented three rare mass lesions of the vulva. The first case presented with the complaint of vulvar lesion since childhood, while the two cases presented in reproductive age and perimenopausal age. All three cases presented as mass lesions in the vulva with pain or uneasiness during work. In all these cases, excision was done. On histopathological examination, the lesions have different diagnoses which are common in other parts of the body, but rarely present at the vulva. A definitive diagnosis of a vulvar mass lesion is difficult to make, especially in the case of rare mass lesion. Histopathology is the principal tool of diagnosis.

Advertising of Pre-Packaged Foods in India: A Qualitative Analysis

Objective: We examined the ‘nutrients of concern’ in pre-packaged food products that are commonly advertised, as per WHO standards and Nova Classification. Methods: This was a qualitative study, using a convenience sampling method, to identify advertisements of prepackaged food products. We also analyzed their content from information on the packets, and their compliance with applicable Indian laws. Results: We found that all the advertisements of the food products in this study did not provide important information about the amount of nutrients of concern i.e., total fat, sodium, and total sugars. These advertisements mostly targeted children, made health claims, and used endorsements of celebrities. All the food products were also found to be ultra-processed in nature and high in one or more nutrients of concern. Conclusion: Most of the advertisements are misleading, needing effective monitoring. Health warnings on the front-of- pack label and restrictions on marketing of such food products may go a long way in reducing non-communicable diseases.

EXPLORING RESILIENCE IN ADOLESCENTS OF MUMBAI METROPOLITAN REGION

Mental health of people in India is becoming a growing concern. Most mental health problems diagnosed in adulthood begin in adolescence. In the context of the Covid-19 pandemic, the concept of resilience gained momentum and deserves special attention. Resilience is a vital skill for navigating life's ups and downs. Resilience is a major and significant asset which adolescents need to combat the adversities and the toll these stressful experiences have on their well-being and mental health. Thus, it is important to explore and understand the resilience among the adolescents. The current paper aims to study the resilience of adolescents with respect to gender, type of family and birth order. The sample comprised of 47 adolescents (13-15 years of age) of Mumbai Metropolitan Region. Data was collected using a researcher made tool. The findings revealed that resilience of adolescents does not vary on the basis of gender, type of family and birth order. Thus, it can be concluded that gender, type of family and birth order has no effect on resilience of adolescents.

Lid wiper epitheliopathy in symptomatic and asymptomatic dry eye subjects

Purpose: Lid wiper epithliopathy (LWE) was stuided in symptomatic and asymptomatic dry eye subjects. This is the first such study to be conducted in the Indian population. LWE is a clinical condition associated with vital staining in the lower and upper eyelids on increased friction of the lid margin over to the cornea. Our aim was to study LWE in symptomatic and asymptomatic (control) dry eye subjects. Methods: Out of 96 subjects screened, 60 subjects were enrolled in the study and were divided into two groups, symptomatic and asymptomatic dry eye subjects, based on the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire and the Ocular Surface Disease Index (OSDI) scores. The subjects were examined to rule out clinical dry eye findings and assessed for LWE with two different dyes (fluorescein and lissamine green). Descriptive analysis was done and Chi?square test was used for statistical analysis. Results: A total of 60 subjects were enrolled in a study with a mean age of 21.33 ± 1.88 years, out of which the majority of LWE patients (99.8%) was seen in the symptomatic group than the asymptomatic group (73.3%); the difference was statistically significant (p = 0.00) and also clinically significant. LWE was found to be significantly higher in symptomatic dry eye subjects (99.8%) compared to asymptomatic dry eye subjects (73.3%). LWE severity was also found to be more (56.6% of grade 3) among symptomatic dry eye subjects compared to asymptomatic subjects (40% of grade 2). Conclusion: It is important to assess the lid wiper region (LWR) and treat LWE in routine clinical practice.

Formulation and Evaluation of Orodispersible Tablet Containing Combination of Phosphodiesterase-5 Inhibitor and Herbal Aphrodisiac

Purpose: Sildenafil citrate is widely used drug for the treatment of Erectile Dysfunction (ED) and Ginseng is a natural aphrodisiac reported to benefit this condition. The objective of the present study was to develop orodispersible tablets (ODTs) containing combination of Sildenafil citrate and Ginseng extract to improve the bioavailability, reduce the dosing frequency and thereby maintaining the therapeutic efficacy of the drug. Methods: The ODTs were prepared using superdisintegrants such as Croscarmellose sodium (CCS), povidone, and sodium starch glycolate (SSG) at varying concentrations (2%, 4% and 6%) by direct compression. The bitter taste of Sildenafil citrate was masked by Doshion resin. The optimized formulation based on least disintegration time (DT) was chosen to reformulate using sublimating agents such as camphor, menthol or thymol at varying concentrations (1%, 2%, 3%) to further reduce the DT. The compatibility of drug with excipients was investigated and the prepared formulations were evaluated for pre and post-compression parameters. Results: The post-compression parameters such as weight variation, hardness, friability, DT and in-vitro drug release was found within specified limit. The formulation with camphor (2%) had DT of 12 sec and drug release >90% within 5 min hence was considered as optimized formulation. The accelerated stability study and kinetics modelling was performed for optimized formulation. Conclusion: The formulated Sildenafil citrate and Ginseng ODT’s were found to be promising formulation with quicker DT and drug release which will eventually have higher bioavailability and better efficacy along with averting the issues of swallowing and improving patient compliance.

Efeito do treinamento pliométrico de curta duração no salto vertical e velocidade de sprint em jogadores de vôlei / Effect of short duration plyometric training on vertical jump and sprint speed in volleyball players

INTRODUÇÃO: O voleibol é um esporte de ritmo acelerado que envolve projeções verticais e horizontais da bola por parte do jogador. O uso de treinamento pliométrico é um método popular para melhorar o desempenho dos jogadores. OBJETIVO: O presente estudo visa verificar o efeito de quatro semanas de treinamento pliométrico em jogadores de voleibol. MÉTODO: Estudo randomizado, controlado, de grupos paralelos. Foram triados 39 participantes para participação no estudo, dos quais 30 foram selecionados seguindo os critérios de inclusão e exclusão da pesquisa. Os critérios de inclusão foram: jogadores de voleibol na faixa etária de 18 a 24 anos, de ambos os sexos, experiência de jogo de no mínimo um ano e disponibilidade para participar. Os critérios de exclusão compreendiam jogadores com histórico de lesão nos últimos seis meses, qualquer distúrbio neurológico ou musculoesquelético e qualquer condição psicológica. Os participantes selecionados foram alocados aleatoriamente no Grupo A e Grupo B usando o método de sorteio. O Grupo A recebeu treinamento pliométrico por três dias em uma semana, e o Grupo B foi solicitado a continuar seus exercícios regulares de rotina. A duração total da intervenção foi de quatro semanas. A medida de resultado para o estudo foi a velocidade do sprint e a altura do salto vertical. A velocidade de sprint foi medida pelo teste de sprint de 20 m e a altura do salto vertical foi medida pelo teste sargent jump. A avaliação foi feita no início e no final de quatro semanas. O teste t não pareado foi usado para analisar as diferenças entre os grupos e o teste t pareado foi usado para analisar as diferenças dentro do grupo nas variáveis de resultado. RESULTADOS: O resultado do estudo mostrou uma melhora significativa na altura do salto vertical (MD= -7,133, IC 95% (-12,657,- 1,609) e nenhuma melhora significativa na velocidade do sprint quando comparações entre grupos foram feitas (MD=0,084, 95% IC (-0,177,-,345) com um tamanho de efeito de 0,75 para a altura do salto vertical. A comparação dentro do grupo foi considerada significativa apenas para a altura do salto vertical no Grupo A, e não houve melhora significativa na velocidade de sprint para ambos Grupo A e B. CONCLUSÃO: Quatro semanas de programa pliométrico é eficaz em melhorar a altura do salto vertical e não a velocidade de sprint em jogadores de voleibol.

INTRODUCTION: Volleyball is a fast-paced sport that involves vertical and horizontal projections of the ball by the player. The use of plyometric training is a popular method to enhance performance in players. OBJECTIVE: The present study aims to see the effect of short-duration plyometric training on vertical jump and sprint speed in volleyball players. METHOD: This study is a parallel group randomized controlled trial. Thirtynine participants were screened for participation in the study, of which 30 were selected following the inclusion and exclusion criteria for the study. The inclusion criteria for the study comprised of volleyball players of age group 18 to 24 years, both males and females, with playing experience of at least one year, and willing to participate. The exclusion criteria for the study included players with a history of injury in the last six months, any reported neurological or musculoskeletal disorder, and any psychological condition. The selected participants were randomly allocated to Group A and Group B using the lottery method. Group A was given plyometric training for three days a week and Group B was asked to continue their regular routine exercises and playing schedule. The total duration of the intervention was four weeks. The outcome measure for the study was sprint speed and vertical jump height. Sprint speed was measured by the 20 m sprint test, and the vertical jump height was measured by the Sargent jump test. The assessment was done at the baseline and at the end of four weeks. An unpaired t-test was used to analyze between-group differences, and paired t-test was used to analyze the within-group differences in the outcome variables. The significance level was set as p<0.05. RESULTS: The result of the study showed a significant improvement in vertical jump height (MD= -7.133, 95% CI-12.657, -1.609) and no significant improvement in sprint speed when between-group comparisons were made (MD=0.084, 95%CI -0.177,-.345) with an effect size of 0.75 for vertical jump height. The within-group comparison was found significant only for vertical jump height in Group A, and there was no significant improvement was found in sprint speed for both Group A and B. FINAL CONSIDERATIONS: The short-duration plyometric training is effective in improving the vertical jump height and not the sprint speed in volleyball players. The specificity of plyometric training is important for optimal improvement in sports performance.

SARS-CoV-2 antigen detection in deceased bodies: implications for infection prevention

Background & objectives: High transmissibility of the SARS-CoV-2 has significant implications on healthcare workers’ safety, preservation, handling, transportation and disposal of the deceased bodies. The objective of this study was to detect SARS-CoV-2 antigen in nasopharyngeal samples and its implications in handling and care of COVID-19 deceased bodies. Methods: A study was conducted at a dedicated COVID-19 centre on deceased individuals from April to December 2020. Rapid antigen test (RAT) and reverse transcription (RT)-PCR was compared on all the SARS-CoV-2 positive cadavers recruited in the study. Results: A total of 115 deceased individuals were included in the study. Of these, 79 (68.7%) were male and 36 (31.3%) were female and majority were in the age group of 51-60 yr [31 (27%)]. SARS-CoV-2 antigen test was positive in 32 (27.8%) and negative in 83 (72.1%) individuals. The mean time interval between deaths to the sample collection was 13.2 h with interquartile range of eight to 20 h. Reverse transcription (RT)-PCR was used as the reference test and 24 (20.9%) cases were true positive; 93.6 per cent [95% confidence interval (CI) 88.8-98.4%] sensitivity, 45.2 per cent (95% CI 35.5-55%) specificity, 60.2 per cent (95% CI 50.6-69.8%) positive predictive value and 88.8 per cent (95% CI 82.7-95%) negative predictive value of antigen test was computed. Interpretation & conclusions: SARS-CoV-2 antigen test was positive beyond 19 h in COVID-19 deceased individuals. Antigen test was found to be highly sensitive in the deceased. Patients, suspected of having died due to COVID-19, can be screened by this method. As infectiousness of the virus in the deceased bodies cannot be directly concluded from either the antigen or RT-PCR test, yet possible transmission cannot be completely ruled out. Strict infection control measures need to be followed during the handling and clearance of COVID-19 cadavers.

HISTOMORPHOLOGICAL STUDY OF CHOLECYSTECTOMIES IN A TERITIARY CARE CENTER

Introduction: Cholecystectomy is the most common surgical procedure performed for cholelithiasis (gall stones). Cholelithiasis is one of the most common gastro intestinal disorder worldwide. Usually asymptomatic, but commonly encountered symptoms may be right upper quadrant pain, dyspepsia and belching. The incidence of cholelithiasis is 2-4 times more in women than in men. The aim of the present study is to identify various morphological patterns and frequency of gall bladder lesions in cholecystectomy specimens. The Materials And Methods: present study was a cross sectional descriptive study of all cholecystectomy specimens received in the department of pathology, NRI Institute of Medical Sciences, Sangivalasa, Visakhapatnam, Andhra Pradesh; conducted over a period of 12 months from September 2021 to August 2022. The relevant and detailed clinical history were taken and processing was done in these specimens for histopathological examination. A total of 80 cholecystectomy specimens were received in the Results: department. Out of which, 79 were in?ammatory gall bladder lesions and only one case was reported as malignancy. The most common age group affected were in 4th to 5th decade with female preponderance comprising of 47cases (58.75%) while the gall bladder carcinoma was reported in 72 years of age. Among the in?ammatory lesions, most common one was chronic cholecystitis comprising of 64 cases, 80.5% (63.6% associated with gall stones) were chronic cholecystitis, followed by 10 cases (12.5%) of acute cholecystitis (100% associated with gall stones), 2cases (2.5%) of polyps & Adenomyomatosis each. Only one case (1.25%) of each Cholesterolosis & gall bladder adenocarcinoma was reported. Chronic cholecystitis is the Conclusion: most common gall bladder disease for which cholecystectomies are being done. The present had reported various morphological patterns encountered in the cholecystectomy specimens received in the department

Bone microarchitecture and bone mineral density in Graves’ disease

Objectives@#Graves' disease (GD) is the most common cause of thyrotoxicosis. There are many studies that have evaluated bone mineral density (BMD) in Graves’ disease. However, the strength of a bone also depends on its microarchitecture which can be assessed by various techniques. Trabecular bone score (TBS) is a new method for assessing bone microarchitecture that is non-invasive and easily performed. @*Methods@#The present study was a cross-sectional study that involved 50 patients with active GD and 50 healthy controls. Both groups were subjected to an assessment of biochemical parameters followed by measurement of BMD and TBS on the same dual energy X-ray absorptiometry (DXA) machine. @*Results@#The mean age of patients with active GD (N = 50) was 31.9 ± 10.9 years while that of controls was 31.2 ± 4.9 years (P = 0.640). The female: male ratio was the same for both groups (F = 31, M = 19). The mean lumbar spine BMD, femoral neck BMD, total hip BMD, and distal radius BMD were significantly reduced in GD when compared to that in controls. The mean absolute lumbar spine TBS in GD was 1.263 ± 0.101 while that in controls was 1.368 ± 0.073 (P < 0.001). On multivariate regression analysis, the factors that predicted TBS were serum thyroxine (T4) and L1-L4 BMD. @*Conclusions@#Patients with Graves’ disease had reduced bone density at all sites and degraded microarchitecture. Long-term studies are required to understand the pattern of recovery of bone microarchitecture after the restoration of euthyroidism.

Low prevalence of primary sclerosing cholangitis in patients with inflammatory bowel disease in India

Background/Aims@#Primary sclerosing cholangitis (PSC) represents the most common hepatobiliary extraintestinal manifestation of inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD). Limited data exist on PSC in patients with IBD from India. We aimed to assess the prevalence and disease spectrum of PSC in Indian patients with IBD. @*Methods@#Database of IBD patients at 5 tertiary care IBD centers in India were analyzed retrospectively. Data were extracted and the prevalence of PSC-IBD was calculated. @*Results@#Forty-eight patients out of 12,216 patients with IBD (9,231 UC, 2,939 CD, and 46 IBD unclassified) were identified to have PSC, resulting in a prevalence of 0.39%. The UC to CD ratio was 7:1. Male sex and pancolitis (UC) or colonic CD were more commonly associated with PSC-IBD. The diagnosis of IBD preceded the diagnosis of PSC in most of the patients. Majority of the patients were symptomatic for liver disease at diagnosis. Eight patients (16.66%) developed cirrhosis, 5 patients (10.41%), all UC, developed malignancies (3 colorectal cancer [6.25%] and 2 cholangiocarcinoma [4.16%]), and 3 patients died (2 decompensated liver disease [4.16%] and 1 cholangiocarcinoma [2.08%]) on follow-up. None of the patients mandated surgical therapy for IBD. @*Conclusions@#Concomitant PSC in patients with IBD is uncommon in India and is associated with lower rates of development of malignancies.

Inflammatory bowel disease (IBD)-disk accurately predicts the daily life burden and parallels disease activity in patients with IBD

The inflammatory bowel disease (IBD)-disk is a validated, visual, 10-item, self-administered questionnaire used to evaluate IBD-related disability. The present study aimed to evaluate IBD-disk in assessment of IBD daily life burden and its relation with disease activity. Methods: A cross-sectional study was conducted between June 2021 and December 2021. Patients with IBD were asked to complete the IBD-disk and a visual analogue scale of IBD daily-life burden (scored from 0–10, score >5 indicative of high burden). The internal consistency of IBD-disk, correlation with IBD daily life burden and disease activity (assessed by partial Mayo score and Harvey Bradshaw Index in patients with ulcerative colitis [UC] and Crohn’s disease [CD], respectively) and diagnostic performance of IBD-disk to detect high burden were analyzed. Results: Out of the 546 patients (mean age 40.33±13.74 years, 282 [51.6%] males) who completed the IBD-disk, 464 (84.98%) had UC and the remaining (n=82, 15.02%) had CD. A total of 311 patients (291 UC and 20 CD; 56.95%) had active disease. The mean IBD-disk total score and IBD daily life burden were 18.39±15.23 and 2.45±2.02, respectively. The IBD-disk total score correlated strongly with the IBD daily life burden (ρ=0.94, P30 predicted high IBD daily-life burden. Conclusions: The IBD-disk accurately predicts the daily life burden and parallels disease activity in patients with IBD and can be applied in clinical practice. (Intest Res, Published online)

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.

Double trouble in an ectopic pregnancy / Philippine Journal of Obstetrics and Gynecology

@#Gestational trophoblastic diseases are histologically different types of tumors originating from the placenta with an incidence of 0.2–5.8/1000 pregnancies. Ectopic pregnancy is the implantation of the fertilized ovum outside the uterine cavity, and a 0.64% incidence is reported. Ectopic cornual pregnancy and molar pregnancy are rare cases, and a combination of these two rare entities occurring simultaneously is even rare and very few cases have been reported in the literature. A cornual pregnancy refers to the implantation and development of a gestational sac in one of the upper and lateral portions of the uterus, whereas an interstitial pregnancy is a gestational sac that implants within the proximal, intramural portion of the fallopian tube that is enveloped by the myometrium. We present one of the rare combinations of molar pregnancy and cornual/interstitial ectopic pregnancy in a 30‑year‑old G3 P1 who presented with a triad of amenorrhea, vaginal bleeding, and abdominal pain. Laparotomy was done in view of an ultrasound which was suggestive of a well‑defined complex thick‑walled lesion of size 3.2 × 3.3 with a gestational sac and no cardiac activity in the right fallopian tube/adnexa suggesting tubal ectopic pregnancy. Beta‑human chorionic gonadotropin (β‑hCG) levels were done and noted to be as high as 9998 mIU/mL. Intraoperatively, a cornual ectopic pregnancy was found with no hemoperitoneum which was excised. Histopathology showed chorionic villi with variable size and hydropic change, myxoid stromal changes, and cistern formation with polar trophoblastic proliferation, based on which a diagnosis of molar pregnancy was made. Although ultrasonography and higher than usual serum β‑hCG levels are diagnostic of uterine molar pregnancy, they do not yield a proper diagnosis in ectopic molar pregnancy, hence, making it difficult to distinguish between an early ectopic molar pregnancy from a nontrophoblastic tubal pregnancy. The final diagnosis is usually made only after histopathology. A high degree of clinical suspicion of cornual pregnancy followed by histopathological examination of the products of conception is the standard for arriving at an appropriate diagnosis. Serial serum β‑hCG level follow‑up is recommended to rule out its malignant potential.

Body Image Issues Among Late Adolescent Boys

Background: Adolescence is the age where individuals undergo a lot of changes. Among the physiological, psychological, social changes, adolescents usually worry about the physical changes that takes place. The rapid changes in the body creates certain confidence in few; and uncertainty and self-doubt in few of the individuals. They are also in the process of creating an identity for themselves and understanding their changing bodies. The present study aimed to investigate the changes in the level of Body Image Issues among Adolescent Boys. Methodology: A purposive sampling of 30 adolescents across Karnataka state, were considered for the study. Body Image questionnaire tool was used. Kruskal Wallis test adopted for statistical analysis; done using SPSS version 22. Results: The mean scores for ages 16-, 17- and 18- years are 43.20, 62.90 and 56.70 respectively. And their corresponding standard deviations are 16.578, 31.328 and 23.262 respectively. The p value obtained is .203. Which indicates that there is no significant difference in the level of Body Image among late adolescent boys. Conclusion: The results indicate that the level of Body image is not significant among late adolescent boys

Cutaneous Features, Autoantibody Profile, and Nailfold Capillaroscopy of Systemic Sclerosis: A Study of 60 Cases

Background: Systemic sclerosis (SSc) is an autoimmune chronic multisystem disorder with a plethora of cutaneous manifestations. These manifestations often may be the only presenting complaint. Early identification of these help in diagnosing grievous systemic manifestations and their prompt and appropriate treatment. Aims: To study the clinical profile of SSc, modified Rodnan’s skin scoring (mRSS), nailfold capillaroscopy (NFC) patterns, antibody profile in the western India population, and their association with cutaneous manifestations. Methods: Patients of SSc fulfilling the European League Against Rheumatism (EULAR) 2013 classification of SSc criteria, who attended dermatology outpatient department (OPD) between January 2017 and September 2018 were included in the study. The demographic data, cutaneous features, autoantibody profile, mRSS, and NFC pattern were noted Results: A total of 60 patients (57 females and 3 males; mean age years) of SSc were evaluated. Clinical subtypes were 40 diffuse cutaneous SSc and 20 limited cutaneous SSc. The most common presenting symptoms were Raynaud’s phenomenon (RP) (95%) and skin tightening (90%). The common cutaneous findings were sclerodactyly (86.7%), stellate scars (78.3%), parrot-beaked nose (76.7%), mask-like facies (75%), microstomia (56.7%), salt and pepper pigmentation (55%), puffy finger (46.7%), telangiectasia (46.7%), digital ulcer (38.3%), fixed flexion deformity (33.3%), and calcinosis cutis (8.33%). Limited cutaneous systemic sclerosis (lcSSc) had mRSS score of 8.3 ± 4.1 and diffuse cutaneous systemic sclerosis (dcSSc) subset had a score of 28 ± 10.4. Antinuclear antibody (ANA), Anti-topoisomerase antibody (ATA), and anti-centromere antibody (ACA) were positive in 59, 49, and 7 patients, respectively. The NFC patterns were early (23.3%), active (45%), and late (18.3%). Limitation: The sample size of the study was small. We were not able to determine the significance of other less common autoantibodies with scleroderma. Conclusion: The study highlights the importance of identifying early cutaneous findings and the role of a useful diagnostic and prognostic reproducible scoring system (mRSS) and NFC.

Emergence of monkeypox virus: a public health threat

The human monkeypox virus is a zoonotic infection that is closely related to smallpox virus. It more commonly exists in forested habitats of western and central Africa. In the recent outbreak of the monkeypox virus, the total number of positive cases escalated to 32,760 and 12 deaths were reported so far. With rodents being primary reservoirs, the virus spreads through animals, fomites, respiratory droplets and, direct contact. It typically presents as a vesiculo-pustular rash along with fever, headache, malaiseand chills. Taking this clinical spectrum into consideration, differential diagnosis to rule out smallpox is very much significant. Though there are no licensed therapies for monkeypox, treatment regimens and vaccination for small pox can also be used formonkeypox. Effective prevention relies on avoiding contact and limiting respiratory exposure with the infected patients by following standard precautions. This review article gives an insight into epidemiology, clinical presentation, diagnosis, transmission, vaccination, and prevention of infection.

A Case of Neonatal Severe Hyperparathyroidism: Challenges in Management

Neonatal severe hyperparathyroidism is a rare disorder arising from inherited defects in the calcium sensing receptor (CaSR) that presents early in life with severe hypercalcemia, failure to thrive, and developmental retardation. The authors describe an infant with neonatal severe hyperparathyroidism due to homozygous CaSR gene mutation presenting with recurrent episodes of severe hypercalcemia, growth retardation, and developmental delay. Medical management served as an efective bridge therapy to surgery. Total parathyroidectomy with right hemithyroidectomy was performed at 7 mo of age and resulted in successful cure and normalization of growth and developmental milestones. Timely medical and surgical management can help prevent mortality and morbidity in the form of neurodevelopmental sequelae. Life-long monitoring and treatment is mandatory for the resultant hypoparathyroidism.

Association of Serum Level of Vitamin D3 and Pulmonary Function in Bronchial Asthma Patients in A Tertiary Care Hospital of South Gujarat, India

Introduction: Asthma is a chronic lung disease characterised by reversible airway obstruction, cellular infiltration, and airway inflammation. The reaction is characterised by the interaction of genetic and environmental variables, as well as the activation of cells in the innate and adaptive immune systems. Method: The study was conducted in the Department of General medicine, in Tertiary Care Center, to study association of serum level of Vitamin D3 and pulmonary function in bronchial asthma patients. As per inclusion and exclusion criteria ,137 patients of bronchial asthma were included in the study. Result: In cases having serum vitamin D3 level <20 ng/ml mean value of FVC, FEV1, FEV1/FVC ratio, was 108.10�.89, 68.56�.40, and 62.35�17. In cases having serum vitamin D3 20-29 ng/ml, mean value of FVC, FEV1, and FEV1/FVC ratio was 109.72�.22, 72.34�.48, and 64.39�97. In cases having serum vitamin D3 >30 ng/ml mean value of FVC, FEV1, and FEV1/FVC ratio, was 115.0�27, 81.0�09, and 70.52�00. Conclusion: Vitamin D3 deficiency was highly prevalent in asthmatic patients, there was a strong correlation between asthma severity and vitamin D3 concentrations and there was a direct and a positive significant correlation between vitamin D3 levels and pulmonary function test in asthmatic patients.

Comparison of Outcomes of Clinical Teaching Station and Traditional Bedside Teaching among the Final Year Medical Students

Background: Teaching clinical skills is generally done by bedside teaching (BT). Clinical teaching stations (CTSs) are specially designed for the final year medics. Methods: The aim was to evaluate and compare the impact of CTS with BT on the final year medical undergraduates. Evaluation of the effectiveness of CTS among the participants was the primary objective with a % change in academic performance. A teaching program was conducted in two phases with each phase having two sessions, covering respiratory system (RS), gastrointestinal tract (GIT), cardiovascular system (CVS), and central nervous system (CNS). In the first phase, RS and GIT and in the second phase CVS and CNS were taught by TS and BT methods. Each session lasted for 2 weeks. Results: Thirty participants were grouped into two. The total mean ± SD score was 22.57 (±3.86) and 24.4 (±4.32) for BT and TS, respectively. Mean scores were higher in students who were taught by CTS but were statistically not significant (p>0.05) in both phases. There was no significant gender difference in the impact of the two teaching methodologies. The number of students who excelled was more with TS whereas, the scores were moderate with BT. All (100%) participants unanimously agreed that CTS is more effective and interactive and helped in better understanding of the subject. Conclusion: TS as a teaching tool is realistic with repeatable clinical scenarios and objective assessment. BT provides students with the required clinical skills, TS can enhance the knowledge and application. TS can be used as a supplementary tool along with BT.