Correlation of serum ST2 levels with severity of diastolic dysfunction on echocardiography and findings on cardiac MRI in patients with heart failure with preserved ejection fraction

Objective: The aim of the present study was to find a correlation of serum Suppression of tumorigenicity 2 (ST2) levels with severity of diastolic dysfunction on echocardiography and cardiac magnetic resonance imaging (CMRI) in heart failure with preserved ejection fraction (HFpEF) patients. Methods: Fifty patients aged _x0001_18 years fulfilling diagnostic criteria for HFpEF were included. ST2 levels, 2D echocardiography and CMRI were performed. Left ventricular ejection fraction, E/A, Septal E/E’, left atrial volume index (LAVI), tricuspid regurgitation (TR), assessment of diastolic dysfunction, T1 mapping in milliseconds and late gadolinium enhancement (LGE) in percentage were noted. The primary outcome measure was to study correlation of ST2 levels with severity of diastolic dysfunction, whereas the secondary outcome measures were to study correlation of ST2 levels with native T1 mapping and LGE on CMRI. Results: ST2 levels showed statistically significant and positive correlation with E/E’ (r ¼ 0.837), peak TR velocity (r ¼ 0.373), LAVI (r ¼ 0.74), E/A (r ¼ 0.420), and T1 values in milliseconds (r ¼ 0.619). There was no statistically significant correlation between ST2 level and LGE in % (r ¼ 0.145). The median ST2 levels in patients with E/E’ > 14 and E/E’ 14 were 110.8 and 36.1 respectively (p-value < 0.05). The mean ST2 levels were significantly higher in patients who had diastolic dysfunction grade III (126.4) and New York Heart Association class IV (133.3). Conclusions: Evaluation of ST2 adds important information to support the diagnosis of left ventricular diastolic dysfunction in patients with HFpEF

Determining PD?L1 expression in head and neck squamous cell carcinoma using immunohistochemistry

Background: Advanced head and neck squamous cell carcinoma (HNSCC) has limited treatment options. Programmed death-ligand1 (PD-L1) expressed by tumor cells interacts with PD-1 receptor on T lymphocytes leading to immune evasive response and survival advantage. Therapy with immune check-point inhibitors target PD-1/PD-L1 blockade inducing tumor regression. Immunohistochemistry (IHC) for PD-L1 expression enables patient selection for immunotherapy and may be considered a potential predictor of clinical response. Methods: A retrospective analysis of IHC for PD-L1 expression using manual laboratory developed technique (LDT) with antibody clone 22C3 (Dako) in 93 cases of HNSCC. PD-L1 expression was correlated with age, gender, tumor site, grade and stage. Results: PD-L1 IHC was performed in 93 cases and immunopositivity was noted in 59 (63.4%) cases. High expression with combined proportion score (CPS) ?50 was seen in 15 (16.1%) cases and low expression with CPS ?1 expression was seen in 44 (47.3%) cases. An almost-perfect interobserver agreement was noted by two pathologists for PD-L1 IHC expression (Cohen’s kappa coefficient = 0.910). No statistically significant correlation was noted between PD-L1 score and patient demographics, tumor site, grade or stage. Conclusion: Detection of PD-L1 status by IHC enables identification of HNSCC patients eligible for future targeted immunotherapy.

Psychological impact, coping strategies used and the effect of ‘brief psychological intervention’ on mental health of healthcare workers during the COVID-19 pandemic

Background: Healthcare workers on the frontline who are directly involved in the treatment of COVID-19 patients are at a special risk of physical, psychological and social impact of the pandemic. This challenging situation is causing various mental health problems like distress, anxiety, depression, insomnia, and fear which affects their decision making ability in treating patients and also has long term physical and psychological implications. This study was aimed at investigating the psychological impact, coping strategies used and the effect of ‘brief psychological intervention’ on mental health of healthcare workers during the COVID-19 pandemic between May and October 2020. Methodology: Total 175 healthcare workers participated in the interventional study. ‘General health Questionnaire-12’ and ‘Impact of Events Scale-Revised (IES-R)’ were used to assess psychiatric morbidity and posttraumatic stress respectively; ‘brief-COPE’ was used for assessing coping strategies used. An oral session of ‘brief psychological intervention’ was delivered and reassessment by IES-R was done 3 months later. Results: Fear of spreading or contracting infection was more among females and nurses. Doctors had higher psychiatric morbidity and posttraumatic stress (PTS); there were no statistically significant gender differences in the same. Participants with higher psychiatric morbidity also had more PTS. Use of approach coping strategies showed least PTS. The interventional module was effective in stress alleviation. Conclusion: COVID-19 pandemic had led to considerable stress among healthcare workers. Imparting regular psychological intervention can help in preparedness and building resilience to tackle the taxing circumstances that have arisen due to the pandemic

A survey to evaluate the efficacy of virechana, basti and knee dhara in patients with Osteoarthritis of knee joint

Background: The objective of this study was to evaluate the role of Virechana (Arhtrox) followed by Kalbasti (14 in number), Knee dhara and Matrabastiin knee osteoarthritis patients.Methods: From OPD of Ayushakti Ayurveda Pvt. Ltd., 60 Patients suffering from knee Osteoarthritis (Janusandhigatavata) were selected randomly as per the inclusion and exclusion criteria. On the basis of specific criteria prepared. Group-I-(30 patients) received only Ayushakti herbs for Osteoarthritis, viz. Painmuktimj, Painmukti sandhical and Painmukti cream for LA Group-II-(30 patients) received Virechana (Arthrox), KalBastikrama (14 Bastis) and Knee dhara with oil followed by Matrabasti (60 ml) twice a week for 6 months along with Ayushakti herbs for Osteoarthritis. Each participant was in the study for 6 months. The entire study duration was 12 months.Result: About 87 patients were enrolled in the study of which 60 completed the study, 27 patients were drop out of the study, at the different stages of project mainly due to poor follow up. Significant reduction in pain was observed in Groups I and II as compared to the baseline (p <0.001) Pain scale (p <0.001).Conclusion: In this study, good relief was offered in knee joint pain, stiffness and mobility, and daily activities like standing, walking, and climbing. Painmukti mj, Painmukti cream and Painmukti Sandhical tablets are Anti-inflammatory, Analgesic but their efficacy can be increased with Virechana.

A Microscopic Study Of Development In Human Fetal Pancreas

Forty aborted human fetuses (25 male, 15 female) of 12–40 weeks gestational age with no obvious congenital abnormality were obtained with the permission of Professor and Head, Department of Obstetrics and Gynaecology of our medical college and prior consent of the parents. The study was approved by the Ethical Committee of our college. These fetuses included spontaneous abortions and stillborns. The pancreas were dissected and paraffin blocks were prepared. The tissue was stained with hematoxylin and eosin. The development of the fetal pancreas at different gestational ages was noted and compared with previous studies.

Correlation of endothelial dysfunction measured by flow-mediated vasodilatation to severity of coronary artery disease

Objectives Brachial artery ultrasound imaging during reactive hyperemia is widely used tool for quantifying endothelium dependent vasomotion. Angiodefender device is used for non invasive determination of percentage flow mediated vasodilation (FMD). An attempt is made to study whether endothelial dysfunction determined by FMD of brachial artery predicts the presence or absence of coronary artery disease and its correlation with the severity of coronary artery disease. Methods One hundred six patients admitted between May 2014 and April 2015 who were posted for coronary angiography diagnosed to have chronic stable angina on clinical basis and/or by exercise stress test, for evaluation of coronary artery disease were submitted to standard clinical evaluation, calculation of percentage FMD by Angiodefender device. Statistical significance of difference of categorical variables was tested using Fisher’s exact test. Sensitivity, specificity, positive predictive value and negative predictive value of FMD were studied. Results There was no correlation between number of risk factors and percentage of FMD. Significantly higher proportion of cases with less FMD had higher prevalence of coronary artery disease and vice-versa. Significantly higher proportion of cases with positive stress test had less percentage of FMD and vice-versa. Significantly higher proportion of cases with less percentage of FMD and positive stress test had higher prevalence of obstructive coronary artery disease and vice-versa. Specificity was 100% when percentage of FMD was ≤10. Conclusions FMD an inexpensive and non-invasive test provides information regarding extent and severity of coronary artery disease.

Comparative study to evaluate efficacy and safety of azilsartan and telmisartan in patients with grade I-II essential hypertension

Background: Objectives of the study was to study the effect of Azilsartan 40mg once daily versus Telmisartan 40mg once daily in patients with Grade I-II essential hypertension.Methods: A prospective study was conducted at MGM Medical college and Hospital which included 80 patients in each group with Grade I–II essential hypertension. The sex, age, presenting illness, and family history of the patients were recorded. Investigations such as blood sugar, urine analysis, kidney function test, lipid profile, and ECG were performed before starting the treatment. Any adverse effects during the treatment were noted. Blood pressure was recorded at baseline and during follow-up. One group received Azilsartan 40mg once daily and another group Telmisartan 40mg once daily. Patients were followed-up every week for 5 weeks.Results: Patients receiving Azilsartan 40mg and Telmisartan 40mg showed a significant fall (P <0.05) in systolic (SBP) at the end of fifth week, when compared to baseline and diastolic blood pressure (DBP) significant fall at fourth and fifth week. The difference in fall in SBP and DBP was insignificant between the groups, after first, second and third week (P >0.05). Adverse effects such as Nasopharyngitis, Upper respiratory tract inflammation, Gastroenteritis, headache, dizziness, and fatigue were reported with both drugs.Conclusions: Reduction of blood pressure with Azilsartan and Telmisartan was similar, but fall in blood pressure from baseline was highly significant in both groups.

Optimization, Development and evaluation of Microemulsion for the release of combination of Guaifenesin and Phenylephrine.

Guaifenesin and Phenylephrine possess greater water solubility but lower permeability and bioavailability. The aim of this study is to develop a microemulsion to overcome these issues. Castor oil, Oleic acid and Emu oil were selected as oil phase. Tween 80 and Span 80 were selected as surfactants.2-propanol and ethanol were selected as co-surfactants. Optimization of co-surfactant was done by taking a series of O/W microemulsions which were formulated by titration method. 32 formulations were formed initially and based on various physical parameters like clarity, Stability, density, viscosity, pH and electrical conductivity, 17 formulations were narrowed down. The particle size study was carried out by zeta analysis and the results proved that the formulations were nano sized. FTIR studies proved that there was not much interaction between the drugs in the formulation. In-vitro dissolution studies were performed for all the 17 formulations individually for both the drugs was found. The optimum formulation where sustained release for both the drugs was found to be in the combination of Oleic acid: Tween 80: Water: 2-propanol (1:3:5:9). This formulation was subjected to ex-vivo diffusion study and the permeation through the membrane was found.

Metabolomics: Current Technology and Future Trends.

The emerging field of metabolomics had profound importance in recent years as its wide applications in the field of drug discovery and drug development. With recent advances in the field of metabolomics it can be proved as a major tool in the process of drug discovery and development. In the agricultural/chemical industry, metabolomics may be used to develop herbicides and pesticides With increasing importance being placed on health and safety related aspects of our food, metabolomics can potentially be a valuable tool to monitor and improve the quality of what we eat; for example, in food processing and quality control, or in plant breeding for improved crop varieties and in the development of novel foodstuffs. The present review reveals the importance of metabolomics in drug discovery along with recent advances in the techniques of metabolomics along with its wide applications in various fields like drug discovery, drug toxicity profiling, food industries especially in food and allied beverages testing.

Male health clinic strategy in control of STI/HIV: A program review.

A community-based, longitudinal interventional study was conducted in a slum in north-east (NE) Mumbai, using a pretested, semi-structured proforma and a pre- and follow-up interview schedule to assess the male health clinic (MHC) strategy as an approach for the control of sexually transmitted infections (STIs) in males. The focus groups that emerged for behavior change communication (BCC) activities were clients in second and third decades of life, unmarried and married but not staying with wife, clients with no permanent place of occupation, clients with habit of alcohol, and illiterate clients. Postintervention, there was an overall increase in STI knowledge score, alcohol habit score, and high-risk sexual activity score. Less than 50% of the clients received advice on substance abuse and information on consequences of STI/human immunodeficiency virus (HIV). The study concluded that MHC strategy is an effective approach for control of STIs in males and recommended strengthening of the weaker components of the strategy with focus on the important client groups.

Histogenesis of Developing Human Thyroid.

In human beings the thyroid gland is one of the largest of the endocrine organs. It is one of the earliest endocrine organs to be differentiated and has an important hormonal role in embryonic development. The importance of thyroid gland is to promote growth and development of the brain during fetal life and for the first few years of post-natal life[1, 2]. The purposes of present study are 1)to study the microscopic structure of the human thyroid in different gestational age groups of normal stillborn foetuses; 2) to correlate the size of thyroid follicles; the nature and amount of colloid content of thyroid follicles at different stages of development. The study was carried out on 50 stillborn normal human foetuses. The microscopic structure of thyroid was studied under light microscope. The study concluded the developmental staging of thyroid as: the precolloid stage; the colloid formation stage; the folliculogenesis stage; secretory activity stage.

Escobar syndrome in three male patients of same family.

We describe three male individuals from a consanguineous south Indian family affected with the multiple pterygium syndrome (Escobar syndrome). Common clinical features included short stature, multiple pterygium, skeletal anomalies, and normal intelligence. The first report of this condition was made in 1902 from this same place (Pondicherry) and the disease received its present popular name Escobar syndrome in 1982. The genetic defect for this condition was identified in 2006 as mutation in the fetal acetylcholine receptor.

Hypothyroidism presenting as Hoffman's syndrome.

Muscle weakness, stiffness and delayed tendon jerk relaxation are usual features of hypothyroidism while muscle hypertrophy, myoedema and wasting are occasionally seen. A 60-year-old male, who presented with proximal muscle weakness and muscle hypertrophy has been reported here. Thyroid function tests, electromyogram and muscle biopsy established the diagnosis of thyroid myopathy with Hoffman's syndrome.

Idiopathic colonic varices.

Idiopathic varices of the colon are rare, with only a few reports in literature. We report 30-year-old man who presented with melena and had hepatic flexure varices detected at colonoscopy. Investigations for portal hypertension were negative. No treatment was given.

Brucella isolated from bone marrow.

A 40 year patient presented with pyrexia of one month duration. Routine work up for fever of unknown origin (FUO) was negative. Bone marrow aspiration and culture done yielded Brucella. Bone marrow cultures are recommended for patients for FUO for whom the routine workup turns out to be negative. Serological tests for brucellosis can be false-negative in some cases of brucellosis due to prozone phenomena.