A large inflammatory fibroid polyp of jejunum with unusual presentation: very difficult to diagnosis in paediatric patient

Inflammatory fibroid polyps (IFP), also known as Vanek tumours, are one of the rarest groups of gastrointestinal tract polyps. They represent 0.1-3.0% of all polyps in this organ system. Most common location is the stomach, mainly the antrum (70%), ileum (19%), and colon (6%). Large polyps of the stomach can cause intermittent obstruction, described as 揵all valve syndrome�. This case report, reported in SMS medical college Jaipur in one year six months old child. We report a case of a 1 year 6 months female child with complaint of abdominal lump noted since 7 days, due to this reduced oral intake. On examination single, around 5�cm size non-tender lump is situated in left hypogastric region. On CECT abdomen shows mesenteric origin, may be desmoid tumour, Castleman disease, mesenteric haemangioma or inflammatory myo-fibroblastic tumour. Further MRI abdomen suggestive of inflammatory myo-fibroblastic tumour or NHL. Tumour marker study shows serum ferritin and LDH level raised. On exploration revealed a single, 6󬊄 cm lobulated jejunal mass encircle the jejunum, for this resection and anastomosis done. On histopathological report, suggestive of inflammatory fibroid polyp. Patient discharged successfully on 6th pod without any complication. Exploration done and a mass, which encircle the jejunum found. Resection and anastomosis done and patient discharged on 6th pod without any complications. Such an occurrence was incidental in the reported case, which can confuse our diagnosis, so knowledge about this type of disease is very important, especially in paediatrics population.

Chronic fistula in ano associated with adenocarcinoma: a case report with a review of the literature

The malignant transformation of chronic fistula in ano is rare, accounting for 3% to 11% of all anal canal malignancies. It results from long-standing inflammation and chronic irritation. No guidelines are available for the management of these cases. We herein present a case report of a 55-year-old man who presented with a history of constipation, perianal pain, and discharging fistula in ano of 4-year duration and underwent fistula surgery with recurrence. Biopsy of the fistulous tract revealed adenocarcinoma. He received neoadjuvant chemoradiotherapy, followed by abdominoperineal excision including excision of the fistulous tract. After 18 months of follow-up, he is free of recurrence. We present this case with a review of the literature, highlighting the management strategies.

Dynamic analysis of acute deterioration in chronic liver disease patients using modified quick sequential organ failure assessment

Background/Aims@#Quick sequential organ failure assessment (qSOFA) is believed to identify patients at risk of poor outcomes in those with suspected infection. We aimed to evaluate the ability of modified qSOFA (m-qSOFA) to identify high-risk patients among those with acutely deteriorated chronic liver disease (CLD), especially those with acute-onchronic liver failure (ACLF). @*Methods@#We used data from both the Korean Acute-on-Chronic Liver Failure (KACLiF) and the Asian Pacific Association for the Study of the Liver ACLF Research Consortium (AARC) cohorts. qSOFA was modified by replacing the Glasgow Coma Scale with hepatic encephalopathy, and an m-qSOFA ≥2 was considered high. @*Results@#Patients with high m-qSOFA had a significantly lower 1-month transplant-free survival (TFS) in both cohorts and higher organ failure development in KACLiF than those with low m-qSOFA (Ps<0.05). Subgroup analysis by ACLF showed that patients with high m-qSOFA had lower TFS than those with low m-qSOFA. m-qSOFA was an independent prognostic factor (hazard ratios, HR=2.604, 95% confidence interval, CI 1.353–5.013, P=0.004 in KACLiF and HR=1.904, 95% CI 1.484– 2.442, P<0.001 in AARC). The patients with low m-qSOFA at baseline but high m-qSOFA on day 7 had a significantly lower 1-month TFS than those with high m-qSOFA at baseline but low m-qSOFA on day 7 (52.6% vs. 89.4%, P<0.001 in KACLiF and 26.9% vs. 61.5%, P<0.001 in AARC). @*Conclusions@#Baseline and dynamic changes in m-qSOFA may identify patients with a high risk of developing organ failure and short-term mortality among CLD patients with acute deterioration.

Role of Demographic Factors on Academic Motivation of Medical Students in a Malaysian Private University

@#Introduction: Medical students are highly motivated compared to other students in higher education. Various factors internal and external to the students can affect their academic motivation. It has direct bearing on their performance as well as their professional development. The present study aims to validate the adapted questionnaire on academic motivation of medical students in Malaysia and to study the influence of gender, ethnicity, and year of study on it. Methods: The quantitative research approach using the cross-sectional survey design is used in the present research. Stratified random sampling method used to collect data from 318 participants using adapted academic motivation scale for college students. The reliability and construct validity of the instrument was evaluated. The data was analysed, for inferential statistics using SPSS version 26. Results: The intrinsic and extrinsic motivation was higher in female medical students. However, the male students are significantly amotivated. Variation in different types of motivation was observed among three ethnic groups. A significant (p<0.005) difference was found in Introjected regulation and amotivation among ethnic groups. Medical students of clinical years had higher score for Intrinsic motivation and lower score for extrinsic motivation. Amotivation was comparable in medical students of all years with lowest in year 2 students. The level of different types of motivation differs among the medical students of different gender, ethnicity, and year of study. Conclusion: The educators and the curriculum designers need to strategize to improve the motivation of the medical students which will improve their academic performance and well-being.

Evaluation of Anti-tumor Properties of Herbal Formulations against Ehrlich Ascites Solid Tumor Mice Model

Saraca indica (Ashoka) is an important plant belonging to the family Fabaceae. It essentially contains glycosides, tannin, saponin, flavonoids, and sterol. It possesses a variety of activities such as analgesic, antipyretic, fungitoxic, anthelmintic, antidiabetic, larvicidal activity, antimicrobial activity, central nervous system depressant activity, antiulcer activity, anti-cancer, and anti-inflammatory activity. The anticancer principle from S. indica flowers indicated 50 percent cytotoxicity (in vitro) in Dalton’s lymphoma ascites and Sarcoma-180 tumor cells at a concentration of 38 mug and 54 mug, respectively, with no activity against normal lymphocytes but preferential activity for lymphocytes derived from leukemia patients. A new plant is also taken as they have no reported activity for in vivo in cancer. One such plant is Solanum xanthocarpum Schrad. and Wendl. (Family: Solanaceae). Various therapeutic properties are attributed to it, particularly in the cure of asthma, chronic cough, and catarrhal fever. Plant contains alkaloids, sterols, saponins, flavonoids, and their glycosides and also carbohydrates, fatty acids, and amino acids. The exact mechanism of action of Kantkari is still unknown due to not reported yet, so the present study was designed to investigate the anti-tumor potential of herbal drugs (Ashoka and Kantkari) against Ehrlich ascites solid tumor mice model. Solid tumors were induced by injecting Ehrlich ascites carcinoma (EAC) cells (15 × 106/mice) subcutaneously in right hind limb. Treatment with drugs (Ashoka and Kantkari) showed significant decrease in body weight, solid tumor volume, and tumor weight in EAC tumor-bearing mice at a dose of 400 mg/kg and 200 mg/kg, respectively. Ashoka increased the mean survival time of tumor-bearing mice and percentage increase in life span (was found to be 90.53% and Kantkari is 88.33%, respectively, which is lower than the standard drug Vincristine but Kantkari shows that the tumor inhibition is more significant than Ashoka. Results of with hematoxylin and eosin and immunohistochemistry explained the possible mechanism of action of drugs (Ashoka and Kantkari). Decreased expression of vascular endothelial growth factor indicated the anti-angiogenic property. Immunochemical analysis of solid tumor showed increased expression of caspase-3 suggested that drugs (Ashoka and Kantkari) induced apoptosis in tumor cells. Findings of the present study explored the possible anti-tumor properties of drugs (Ashoka and Kantkari) and can be room for further evaluations in clinical studies.

Myths, misconceptions and attitudinal trends among patients with acne

Background: Despite acne being a common dermatological problem, there is a paucity of literature addressing the knowledge, attitude and practice about it. Aims/Objectives: To find out what patients know about acne, its cause and treatment, as well as myths, misconceptions and attitude towards it. Methods: A cross-sectional, descriptive questionnaire-based study on acne patients at Maharana Bhupal Hospital, RNT Medical College, Udaipur, Rajasthan, India. Results: Most (84.8%) patients belonged to the age group of 16–25 years. The majority (63.9%) presented 12 months after the onset of acne. More than half had average knowledge, a positive attitude and good practices, related significantly to gender and education. Limitations: A standardized questionnaire suitable for all dialects and regional languages would have yielded more uniform results. Conclusion: Study revealed that acne patients still need to acquire accurate, adequate and easily accessible information to seek timely and appropriate treatment, and alleviate their psychological suffering.

Genetic Divergence Study in Different Rice (Oryza sativa L.) Genotypes under Irrigated and Drought Stress Condition

Thirty rice genotypes were evaluated to study genetic divergence under irrigated and drought stress conditions in randomized block design at Bagusala farm, M. S. Swaminathan School of Agriculture, CUTM, Odisha, during summer 2019. The main objective of this experiment was to identify reproductive phase drought tolerant genotypes through study the effect of drought stress on yield, yield attributing and biochemical traits performance of selected genotypes using Mahalanobis D2 statistics. Set of 30 genotypes were grouped in to five and nine clusters under irrigated and drought situation. Under irrigated conditions cluster-Ⅰ was largest cluster with 22 genotypes followed by cluster-Ⅱ includes 5 genotypes cluster-Ⅲ, IV and V each consisted with only one genotype. Under drought condition, genotypes were grouped into nine different clusters, cluster-Ⅰ was the largest cluster involving 20 genotypes followed by cluster-Ⅱ having 3 genotypes whereas, cluster-Ⅲ, IV, Ⅴ, Ⅵ, Ⅶ, Ⅷ and Ⅸ were recorded with single genotype. The maximum intra cluster distances under irrigated conditions were found in cluster- Ⅱ (27111.9) followed by cluster-Ⅰ (17587.7). Whereas, in case of stress cluster-Ⅱ had maximum distance (21110.9) fallowed by cluster-Ⅰ (17957.8). Under irrigated maximum inter-cluster distances recorded between cluster-Ⅱ and Ⅴ (62310.8) followed by cluster-Ⅳ and Ⅴ (57656.0). In case of stress maximum inter cluster distances recorded between cluster -Ⅱ and Ⅶ (69865.5) fallowed by cluster- Ⅷ and Ⅸ (67848.9), cluster-Ⅱ and Ⅸ (65239.2). Under irrigate conditions highest manifestation towards genetic divergence was exhibited by chlorophyll followed by plant yield, 1000 grain weight, proline, number of spikelets, carbohydrates, grain weight, phenols, panicle length, panicle weight, flavonoids, number of filled grains, plant height and number of tillers. In case of drought stress, maximum percentage contribution towards to the genetic divergence was observed for Proline followed by carbohydrates, plant height, plant yield, grain weight, chlorophyll, number of spikelets, flavonoids, 1000grain weight, filled grains, phenols, panicle weight, panicle length and number of tillers, while other trait like root length did not contribute to the total divergence. The genotypes grouped under cluster Ⅰ, Ⅲ, Ⅴ, Ⅷ namely MTU1010, MTU1075, MTU1224, RNR2465 and Manipur black rice exhibited maximum drought tolerance under stress conditions. These genotypes can be used as the donor parents for development of drought tolerant lines in crop improvement programme.

Microbial keratitis and antibiotic sensitivity patterns: A retrospective analysis at a tertiary center in Central India

Purpose: To report on the microbiological profile and antibiotic sensitivity patterns of infectious keratitis at a tertiary center in central India. Methods: The suspected case of severe keratitis underwent microbiological culture and identification using the VITEK 2 technique. Antibiotic susceptibility for different sensitivity and resistance patterns was analyzed. Demographics, clinical profile, and socioeconomic history was also documented. Results: Culture was positive in 233/455 (51.2%) patients. Pure bacterial growth was present in 83 (35.62%) patients and pure fungus was present in 146 (62.66%) patients. The most common bacterial cause of infectious keratitis was Pseudomonas followed by Staphylococcus and Bacillus. Pseudomonas showed 65%–75% resistance against levofloxacin, ceftazidime, imipenem, gentamycin, ciprofloxacin, and amikacin. Staphylococcus showed 65%–70% resistance against levofloxacin, erythromycin, and ciprofloxacin, with Streptococcus being 100% resistant to erythromycin. Conclusion: This study highlights the current trend of microbiological profiles of infectious keratitis and their antibiotic susceptibility at a rural setup in central India. Fungal predominance and increased resistance against the commonly used antibiotics were noted.

Netarsudil monotherapy as the initial treatment for open-angle glaucoma and ocular hypertension in Indian patients: A real-world evaluation of efficacy and safety

Purpose: Glaucoma is the second leading cause of blindness worldwide, affecting more than 64 million people aged 40–80. The best way to manage primary open?angle glaucoma (POAG) is by lowering the intraocular pressure (IOP). Netarsudil is a Rho kinase inhibitor, the only class of antiglaucoma medications that reorganizes the extracellular matrix to improve the aqueous outflow through the trabecular pathway. Methods: An open?label, real?world, multicentric, observation?based 3?month study was performed for assessing the safety and ocular hypotensive efficacy of netarsudil ophthalmic solution (0.02% w/v) in patients with elevated IOP. Patients were given netarsudil ophthalmic solution (0.02% w/v) as a first?line therapy. Diurnal IOP measurements, best?corrected visual acuity, and adverse event assessments were recorded at each of the five visits (Day?1: screening day and first dosing day; subsequent observations were taken at 2 weeks, 4 weeks, 6 weeks, and 3 months). Results: Four hundred and sixty?nine patients from 39 centers throughout India completed the study. The mean IOP at baseline of the affected eyes was 24.84 ± 6.39 mmHg (mean ± standard deviation). After the first dose, the IOP was measured after 2, 4, and 6 weeks, with the final measurement taken at 3 months. The percentage reduction in IOP in glaucoma patients after 3 months of once?daily netarsudil 0.02% w/v solution use was 33.34%. The adverse effects experienced by patients were not severe in the majority of cases. Some adverse effects observed were redness, irritation, itching, and others, but only a small number of patients experienced severe reactions, as reported in a decreasing order: redness > irritation > watering > itching > stinging > blurring. Conclusion: We found that netarsudil 0.02% w/v solution monotherapy when used as the first?line treatment in primary open?angle glaucoma and ocular hypertension was both safe and effective.

Government Health Insurance Schemes and Their Benefits to The Indian Population: An Overview

In today’s scenario accelerating cost of health significantly impact the health of people and the populace creat-ing a monetary burden on poor households. One of the key concerns while tackling healthcare disparities is out-of-pocket expenses (OOPE). Providing financial safety and provide universal coverage to the entire popu-lace are the main goal of health schemes. Health policies in India are based on equity prioritising the needs of the poor and underprivileged. Likewise, there is a discrepancy in the consistency of information and knowledge regarding the scheme among the beneficiaries. A review was created to help medical and nursing professionals to gain comprehensive knowledge of various health schemes. We tried to give an overview of various health schemes including Ayushman Bharat Yojana, Aam Aadmi Bima Yojana (AABY), Pradhan Mantri Suraksha Bima Yojana (PMSBY), Rashtriya Swasthya BimaYojana (RSBY), Central Government Health Scheme (CGHS), Employees State Insurance Scheme (ESIC), Employee Health Scheme and various state-level health schemes. include, Yeshasvini Health Insurance Scheme, Mahatma Jyotiba Phule Jan Arogya Yojana, Chief Min-ister Comprehensive Health Insurance Scheme, Mukhyamantri Amrutum Yojana, Karunya Health Scheme, Awaz Health Insurance Scheme, Telangana State Govt Employees and Journalist Health Scheme, Dr Ysr Aarog-yastri Health Care Trust, Mukhyamantri Chiranjeevi Yojana, Rajasthan Government Health Scheme (RGHS), and Aarogya Raksha.

Impacts of Different Irrigation Schedules and Nutrients Management Practices on Economics of Wheat

A field investigation was conducted during two kharif seasons of 2020-21 and 2021-2022 at Agriculture Research Farm, Rabindranath Tagore University, Raisen, Madhya Pradesh, India, to evaluate the effect of different irrigation scheduling and nutrient management practices on yield and economics of wheat crop in split-plot design with three replications. The irrigation level N0 - No irrigation, N1- One Irrigation at CRI (crown root inition) stage, N2- One Irrigation at CRI & one irrigation before flowering were arranged in main plots whereas nutrient management treatments of N0 – Control, N1-100% RDF + FYM @ 2.5 t/ha. + Azotobacter, N2 - 100% RDF + Vermicompost @ 1.5 t/ha + PSB, N3 - 50% RDF+ FYM@5.0 t/ha, N4 -50% RDF+ Vermicompost@2.5 t/ha were used in the sub plots. The results shown that one Irrigation at CRI & one irrigation before flowering along with application of 50% RDF+ FYM@5.0 t/ha found to be best in the terms of grain and straw yield 28.70 and 41.88 q ha-1 in 2021 and 29.52 q ha-1, 42.13 q ha-1 in 2022. Minimum yield and cost benefit ratio recorded under control plot. The study suggests economically combinations of currently used irrigation scheduling and nutrient management practices that may help farmer to obtaining optimum yield.

Expert Opinion by Clinicians on the Use of Insulin Therapy in People with Hepatic Impairment

People with type 2 diabetes mellitus (T2DM) have a higher risk of developing chronic liver disease (CLD) and its complications. T2DM, obesity, and insulin resistance are all strongly associated with nonalcoholic fatty liver disease (NAFLD). Conversely, people suffering from cirrhosis have reduced glucose tolerance in approximately 60% of cases, diabetes in 20% of cases, and insulin-mediated glucose clearance is lowered by 50% as compared with those who do not have cirrhosis. An exploratory review was conducted using existing published evidence from clinical studies on dosing and titrations of individual insulin formulations in people with CLD to optimize insulin dosage titration for minimizing hypoglycemia risk. This article discusses current hyperglycemia treatment techniques for patients with CLD as well as the consensus recommendations on insulin use in special populations with T2DM and hepatic impairment. Based on available evidence and expert diabetologists’ recommendations, careful insulin dose titration, customized glycemic targets, and frequent glucose screening are recommended for optimal glycemic management without hypoglycemia in CLD. Long-acting insulin should be avoided or used when short-acting insulin fails to provide adequate glycemic control with raised fasting blood sugar levels. While the patient’s glucose profile is being evaluated, the prandial insulin dose can be lowered by 25% initially. The dose can be titrated based on the patient’s postprandial glycemic expression and whether their food intake meets the Child–Pugh scores A and B categories. Titrating premixed insulins is difficult for patients in class C since their appetite and overall health are constantly compromised and in flux.

Residual Effect of Integrated Nutrient Management in Kharif Maize (Zea mays L.) on Growth and Yield of Toria (Brassica campestris L. var. Toria) during Rabi Season in Odisha, India

A field experiment was carried out at Regional Research and Technology Transfer Station (OUAT), Semiliguda of Koraput district under Eastern Ghat High Land zone of Odisha in acidic soil during two consecutive rabi seasons of 2016-17 and 2017-18 to study the residual effect of integrated nutrient management in maize on succeeding toria crop. The experiment was laid out in randomized block design with three replications consisting of twelve treatments. The present investigation revealed that application of soil test based fertilizer with green leaf manure (cowpea), FYM @ 5 t ha-1 and biofertilizer (Azotobacter + Azospirillum + PSB @ 4 kg ha-1 each) to maize crop registered maximum residual effect thereby resulted significantly highest seed yield (6.3 q ha-1) and stover yield (11.1 q ha-1) of toria with a net monetary return of Rs. 7025 ha-1 and benefit cost ratio of 1.38.

RADIOLOGIC-PATHOLOGIC CORRELATION OF EXTRANODAL EXTENSION IN PATIENTS WITH SQUAMOUS CELL CARCINOMA OF THE ORAL CAVITY

Background: The purpose of this study was to assess the accuracy of preoperative CT imaging for predicting pathologic nodal ECE (pECE). To estimate the accuracy of the presence of radiologic extranoda AIM: l extension (rENE) in reference to pathologic extranodal extension (pENE) in patients with oral cavity squamous cell carcinoma (OSCC) MATERIALS AND METHODS: This is a prospective study in GSVM Medical College, LLR & Associated Hospitals, Kanpur (UP). The records of 50 consecutive patients with oral cavity cancer (OCC) who underwent preoperative CT imaging before initial surgical resection and neck dissection between 2020 and 2021 were reviewed. Specimens with pECE had the extent of ECE graded on a scale from 1 to 4. Radiographic ECE was RESULTS: documented in 6 patients (12%), and pECE was observed in 11 (22%). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 45.4%, 97.4%, 83.6%, and 86.3%, respectively. The sensitivity of radio- graphic ECE increased from 40% for grade 1 to 2 ECE, to 50% for grade 3, and 50% for grade 4. Radiographic ECE criteria of adjacent structure invasion was a better predictor than irregular borders/fat stranding for pECE. Radiographic ECE has poor sensitivity, but excellent spec CONCLUSION:Radiographic ECE criteria ificity for pECE in patients who undergo initial surgical resection. PPV and NPV are reasonable for clinical decision making. The performance of preoperative CT imaging increased as pECE grade increased.

Health Literacy and Clinic-Epidemiological Profile of Patients with COVID-19-Associated Mucormycosis: A Questionnaire-Based Study

Background: The patient partnership is desirable for the optimal management of comorbidities. This became significant more so during the coronavirus disease 2019 (COVID-19) crisis wherein health infrastructure was overburdened. Objectives?The aim of this study was to estimate the clinicoepidemiological profile, health literacy regarding predisposing risk factors, and disease management in patients with COVID-19-associated mucormycosis (CAMCR). Materials and Methods?A structured questionnaire-based study on randomly chosen 100 microbiologically proven patients of CAMCR, consisting of 38 multiple choice questions, was designed with each answer having a patient and assessor response to it. Results?A male predilection was seen (68%) with rhino-orbital (73%) being the commonest anatomic site. Forty-nine percent of the study participants had pre-existing diabetes of which 62% did not carry out regular blood sugar monitoring and in 18%, blood sugars were controlled prior to COVID-19. Thirty-five percent of patients with mild COVID-19 illness were treated with unwarranted steroids and 56% of patients had fluctuating blood sugar levels, during COVID-19 illness. Seventy-nine percent of patients were not vaccinated against COVID-19, 16% only partially vaccinated. Seventy-one percent of patients were not aware of red flag signs and of mucormycosis with 8% presenting early, on noticing nasal symptoms. Conclusion?This study observed diabetes as the most common comorbidity in patients with CAMCR. A lacuna in the health literacy of diabetics presenting with CAMCR was found. Additionally, knowledge regarding glycemic control during COVID-19 illness with or without the use of steroids and awareness of the “red flag” signs of CAMCR were mostly lacking. Interventions to improve awareness amongst patients with diabetes should help in optimal glycemic control, and avoid potential complications like severe COVID-19 illness, and mucormycosis

A Case Report of Ischemic Stroke in an Adult Patient of Dengue Fever with Thrombocytopenia

Neurological complications in Dengue patients are extremely rare with 0.5-6% incidence including encephalopathy, Guillain Barre Syndrome, Brachial neuritis, Myelitis, Encephalomyelitis. Stroke as a neurological complication is extremely rare with very few cases reported previously. We present the case of a 69-year-old male with Dengue fever where the patient presented with persistent hiccups was found to have pontine infarct.

Isthmocele: emerging emergency

An isthmocele, a caesarean scar defect or uterine niche, is any indentation representing myometrial discontinuity or a triangular anechoic defect in the anterior uterine wall, with the base communicating to the uterine cavity, at the site of a previous cesarean section scar. With rise of caesarean sections, incidence of isthmocele and scar ectopics is on rise, being 19 to 88% in caesarean delivery patients. As there are no definitive criteria for diagnosing an isthmocele, several imaging methods can be used to assess the integrity of the uterine wall and thus diagnose an isthmocele. However, transvaginal ultrasound and saline infusion sonohysterography emerge as specific, sensitive and cost-effective methods to diagnose isthmocele. When cervix is encroached as well by ectopic placentation, situation becomes much more alarming and grave. Timely diagnosis and active management of the entity is a must to save life of patient. Area of isthamocele bearing ectopic gestation sac has to be excised whatever be the method, by endoscopy or conventional open method. Previous gestation scar dehiscence or rupture of uterus repair leads to more weakness and impaired integrity of uterine wall. If patient refuses to undergo simultaneous sterilization, recurrence of isthmocele formation and ultimate scar ectopic will be even higher. Here we presented a case of ectopic gestation in isthmocele complicated by its extension to cervix with an associated posterior wall cervical fibroid at same level.

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.

Antioxidants Role Against Acrylamide Toxicity on Urogenital System: An Overview

@#Acrylamide (AA) is a chemical substance which is used as a soil stabilizing agent and in the production of copolymers and polymers since 1970. The presence of an AA adduct in food was observed in rats fed with fried food which led to a substantial increase in levels of hemoglobin adduct. Foods that are rich in carbohydrate when prepared at high temperature (above 120 ºC) by baking, toasting, frying, roasting or cooking results in the production of AA by the reaction of the amino acid with glucose present in it. Several studies observed AA toxicity on nervous system, reproductive system, and immune system. To justify this toxicity there is not a clear mechanism described. In this review article the mechanisms of AA toxicity on urogenital system and role of antioxidants against its toxicity has been reviewed. According to previous studies the main factor that induces AA toxicity is oxidative stress. AA treated groups revealed degeneration of the kidney’s epithelial lining and the glomerular tuft. Adverse effect on reproductive system by AA has been evidenced by sperm-head abnormalities, dominant lethal effects, and testicular epithelial tissue degeneration. Therefore, it is advised that modifying of food processing methods and consuming lot of vegetables and fruits containing antioxidants. These antioxidants give us some supports to the cells of our body organs against the AA sources which cause cell defects.

Cultural Competency of Medical Students: An Asian Context

@#Introduction: People of different cultures perceive health and disease differently. A culturally competent healthcare team is needed to provide quality healthcare. In Asian medical schools, less emphasis is laid on cultural competency training. In this context, the study aims to assess the cultural competency of medical students in Malaysia and to fathom the demographic factors influencing it. Methods: A cross sectional survey was conducted on students from all five years of a Malaysian medical school using an adapted version of Clinical Cultural Competency Questionnaire (CCCQ) to tap the self-perceived knowledge, skills, comfort level in cross-cultural encounters and attitude towards cultural competency. Descriptive and inferential statistics was used to analyse the data. Results: Among the 291 respondents, the cultural competency was found to be significantly different among medical students of different year of study, age, and ethnicity. However, with regards to gender, country of birth or the number of languages spoken, the difference was insignificant. The clinical year students had significantly higher scores on the knowledge, skills, comfort level and attitude domains of cultural competency when compared to the preclinical students. Chinese students’ perception on cultural competence was significantly distinct from Indian and Malay students. Conclusion: Exposure to cross cultural encounters in clinical settings and personal experiences seem to influence cultural competency of the medical students. It provides valuable data to plan for interventions, training and self-development strategies aimed at providing culturally attuned patient centred care.