A meta-analysis of ferric carboxymaltose versus other intravenous iron preparations for the management of iron deficiency anemia during pregnancy

Abstract Objective: We conducted a meta-analysis of randomized clinical trials evaluating the clinical effects of ferric carboxymaltose therapy compared to other intravenous iron in improving hemoglobin and serum ferritin in pregnant women. We also assessed the safety of ferric carboxymaltose vs. other intravenous iron. Data source: EMBASE, PubMed, and Web of Science were searched for trials related to ferric carboxymaltose in pregnant women, published between 2005 and 2021. We also reviewed articles from google scholar. The keywords "ferric carboxymaltose," "FCM," "intravenous," "randomized," "pregnancy," "quality of life," and "neonatal outcomes" were used to search the literature. The search was limited to pregnant women. Selection of studies: Studies related to ferric carboxymaltose in pregnancy were scanned. Observational studies, review articles, and case reports were excluded. Randomized studies in pregnant women involving ferric carboxymaltose and other intravenous iron formulations were shortlisted. Of 256 studies, nine randomized control trials were selected. Data collection: Two reviewers independently extracted data from nine selected trials Data synthesis: The final effect size for increase in hemoglobin after treatment was significant for ferric carboxymaltose vs. iron sucrose/iron polymaltose (standard mean difference 0.89g/dl [95% confidence interval 0.27,1.51]). The final effect size for the increase in ferritin after treatment was more for ferric carboxymaltose vs. iron sucrose/iron polymaltose (standard mean difference 22.53µg/L [-7.26, 52.33]). No serious adverse events were reported with ferric carboxymaltose or other intravenous iron. Conclusion: Ferric carboxymaltose demonstrated better efficacy than other intravenous iron in increasing hemoglobin and ferritin levels in treating iron deficiency anemia in pregnant women.

Identification of rare atypical BCR-ABL1 transcript: A case report

CML is characterized by the presence of a BCR-ABL1 fusion transcript. Several guidelines have been published for its detection and molecular monitoring. Here, a case is described of chronic myeloid leukemia presenting in the blast phase with a rare variant transcript, with a discussion on possible red flags in its detection and genetic testing and description of the patient's clinical characteristics. This case highlights the pitfalls of using real-time quantitative reverse-transcription polymerase chain reaction (RQ-PCR) for diagnosis of CML, especially when the clinical picture and the test results are discordant.

Problem Solving And Decision Making As Correlates Of Interpersonal Relationships Of Secondary School Students

Education is an intentionally trained activity focusing at nurturing the harmonious progress of an individual as productive, promising and reasonable individual in the society . A person needs set of skills to deal productively with life situations. Such skills are called life skills which help the person to deal effectively with any condition to get the desired outcomes. The present investigation was designed as a descriptive study and normative survey was the method adopted for the study. Stratified sampling technique has been used to select samples of 60 secondary school students. Problem solving inventory, decision making inventory and inter personal relationship questionnaire were the tools used. The data were analyzed through destructive measures of statistics mainly Mean and Standard Deviation and product moment correlation. From the findings, it can be concluded that there is no significant correlation between problem solving skill and interpersonal relationship, decision making and interpersonal relationship of secondary school students.

Sclerosing angiomatoid nodular transformation of spleen with calcifying fibrous pseudotumor: A rare case with unusual association

Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a rare benign vascular lesion of the spleen that was first described in 2004. SANT is associated with other concurrent diseases, mostly malignancies. Calcifying fibrous pseudotumor (CFPT) is a tumor-like lesion usually arising from soft tissue or peritoneal sub-serosa. Both SANT and CFPT are considered to be variants of the inflammatory myofibroblastic tumor. We report the rare case of a 24-year-old female presenting with a left abdominal mass that was clinically diagnosed as an extraintestinal gastrointestinal stromal tumor (GIST). Histopathological examination revealed SANT of spleen and CFPT. We report this case due to its rarity of occurrence and unusual association of SANT with CFPT.

Coenzyme Q10 in Male and Female Infertility

Infertility is a medical condition that can cause psychological, physical, mental, spiritual, and medical detriments to the patient. Infertility can also be a marker of an underlying chronic disease associated with infertility. It is currently affecting one out of six couples worldwide. The pathophysiology of male and female infertility is multifactorial and still not fully elucidated. Both are related to an imbalance between the production of Reactive Oxygen Species (ROS) and antioxidant defences. Antioxidants are biological and chemical compounds that are synthesized endogenously or exogenously, counteract oxidative stress and act as free radical scavengers. Coenzyme Q10 (CoQ10) is a lipidsoluble quinone acting as an effective antioxidant, which prevents lipid peroxidation and DNA oxidation. It empowers the body’s energy production cycle through Adenosine Triphosphate (ATP) synthesis and has long been used to ameliorate infertility outcomes. Evidence suggests that CoQ10 shows beneficial effects on semen quality, quantity, and mobility in male infertility. Moreover, the potential benefits of oral antioxidants on female infertility treatment are being increasingly investigated, including CoQ10. CoQ10 treatment significantly increases fertilization rate, the number of high-quality embryos, and higher clinical pregnancy and live birth rates. Furthermore, CoQ10 administration enhances ovarian response to stimulation and improves oocyte and embryo quality. Hence, available evidence and clinical studies suggest that CoQ10 supplementation could be considered an inexpensive, safe therapy to enhance infertility treatment in men and women of reproductive age

A Comparative Study on the Efficiency of Commercial Reverse Transcriptase–Polymerase Chain Reaction Kits for the Detection of Severe Acute Respiratory Syndrome Coronavirus 2 Infections

Background: Real?time reverse transcriptase–polymerase chain reaction (RT?PCR) kits have been reliably employed for the diagnosis of coronavirus disease 2019 (COVID?19) by the detection of the severe acute respiratory syndrome coronavirus 2 (SARS?CoV?2) RNA since the beginning of the disease outbreak. In consideration of reliable diagnosis, apart from RT?PCR, the isothermal nucleic acid amplification?based point-of-care automated kits have also been tagged as a simpler and rapid alternative to the conventional techniques. Currently, the availability of a better diagnostic method for COVID?19 when compared to RT?PCR is nil. The most important step in the detection of SARS?CoV?2 in a RT?PCR diagnostic laboratory is to identify and employ RT?PCR kits with higher sensitivity as well as specificity. Objectives: This study aimed to study commercially available RT?PCR kits for the detection of SARS?CoV?2 infections. Methods: The performance of seven different RT-PCR kits from different manufacturers used for diagnosis of COVID-19 in Govt Theni Medical College and Hospital, Theni, Tamil Nadu were analysed. Nasopharyngeal and oropharyngeal swabs were collected from patients and subjected to RT-PCR using these kits. Results and Conclusion: The sensitivities and batch effects of the assessed kits were slightly different for different targets, for SARS?CoV?2 detection in nasopharyngeal swab specimens. Examination of COVID-19 kits should be done using currently employed kits in routine diagnosis for better efficiency

A prospective and observational study on the variation in Hemoglobin A1c levels among asthmatic children using inhaled corticosteroids

Background: The studies in children regarding the effects of inhaled corticosteroids (ICS) on the carbohydrate metabolism are scant in India. This study was undertaken to determine if there is any effect of inhaled steroids on the glycemic control. Aims and Objectives: The aim of the study was to analyze the pattern of glycated hemoglobin (HbA1c) levels in children with persistent asthma, before and after using prophylactic doses of ICS and to evaluate and compare HbA1c levels separately in those taking budesonide and in those taking fluticasone or other steroids. Materials and Methods: It was a prospective and observational study, based on a study proforma. Children of 2–12 years of age, diagnosed with mild-to-moderate persistent asthma, attending the Asthma Clinic at Paediatrics Department of SAT Hospital, Government Medical College, Thiruvananthapuram were included in the study. The diagnosis of asthma and the severity was recorded according to Global Initiative for Asthma guidelines. The sample size was calculated to be 40. Type, dose, and frequency of administration of ICS and other coprescribed drugs were recorded on an asthma diary and entered into the study proforma. HbA1c levels were measured in children before they were started on ICS, on the same day of visit using high perfusion liquid chromatography technique and repeated after 6 months. Student’s t-test was used to compare mean values between two groups. Results: Mean age of patients is 5.75. About 62.5% of patients were males. About 72.5% of the patients had a diagnosis of moderate persistent asthma. The mean HbA1c before the treatment with ICS was 5.36 and after the treatment is 5.37 and the difference was not significant. Conclusions: There was no significant change in HbA1c levels with the use of ICS.

Persistence of symptoms after Covid-19 infection in Kerala

BACKGROUND Persistence of symptoms following Covid-19 infection has now been recognized as an upcoming public health crisis. Understanding these persistent symptoms and quantifying them is vital in planning care for these patients. Studies from India estimating the magnitude of these persistent symptoms are scarce. We aimed to estimate the proportion of symptoms that persist among patients who have recovered from Covid-19 infection. METHODS We conducted this descriptive study among 114 individuals after they recovered from Covid-19 infection. Participants diagnosed as Covid-positive at a tertiary care centre were included in the study. Data were collected from the participants through an online platform. Frequency and proportion of various persistent symptoms were estimated. Analysis was done using SPSS version 16. RESULTS The mean (SD) age of the study participants was 35.5 (15.7) years. Women comprised 62.3% (n=71) of the population. Persistent symptoms were reported by 66 (57.9%; 95% CI 53.07–62.72) participants. The most common symptoms reported were fatigue (n=45, 39.5%) and joint pain (n=23, 20.2%). Those who required hospitalization for longer duration were found to be more associated with having persistent symptoms (p=0.018). CONCLUSION A sizable proportion of individuals had persistent symptoms after recovering from Covid-19 infection. Health facilities should be equipped to address these emerging issues.

COLORECTAL CANCER IN YOUNG ADULTS: A CASE SERIES

Introduction & Background: Colorectal cancer (CRC) is a frequent tumor in adults, it rarely occurs before the age of 25 years, with an annual incidence of only 1-2 cases per 10,00,000 people, accounting for only about 80 cases per year worldwide. Overall incidence of CRC involving hepatic ?exure is 2%, ascending colon is 5%, sigmoid colon is 21% which is very rare in young age group. Herein we report a 3 rare cases of CRC in young adults less than 25 years of age involving hepatic ?exure, ascending colon and sigmoid colon respectively. Case Description: Case 1: A 20 year-old male presented with complaints of abdominal distension and constipation for 1 week and loss of weight for 1 month. Patient had no comorbities and no family history of malignancy. CECT done showed an asymmetric wall thickening involving proximal transverse colon with signi?cant luminal narrowing. He underwent emergency laparotomy and intra operatively patient had a growth at hepatic ?exure of colon with dilated ascending colon, caecum and distal ileum and multiple enlarged mesenteric lymph nodes. He was proceeded with right hemicolectomy with ileo transverse anastomosis. Post operative histopathology revealed mucinous adenocarcinoma involving hepatic ?exure. Case 2: A 25 year-old female was hospitalized due to com plaint s of abdominal pain for 3 months, lower abdomen mass for 1 month and melena for the past 15 days and loss of weight and appetite. Patient had no comorbities and no family history of malignancy. CECT done showed a suspicious wall thickening involving ascending colon. The patient was taken up for laparotomy and per operative ?ndings showed a ulceroproliferative growth involving ascending colon. Patient was proceeded with right hemicolectomy with ileo transverse anastomosis. Post operative histopathology revealed mucinous adenocarcinoma involving ascending colon.Case 3: A 22 year-old male was admitted for comp laint s of lower abdominal pain for 4 months, bleeding per rectum on and off for 1 month and abdomen distension and constipation for 5 days and loss of weight and appetite. Patient had no comorbities and no family history of malignancy. CECT done showed a circumferential wall thickening involving sigmoid colon. Hence the patient was proceeded for emergency laparotomy and per operative ?ndings showed a stenosing growth involving sigmoid colon. Patient was proceeded with Hartmann's procedure. Post operative histopathology revealed adenocarcinoma involving sigmoid colon. Conclusion: Within a young group, CRC is usually diagnosed later andpotentially associated with worst prognosis. Detecting CRC at an early, more treatable stage is important for cure and survival. This report suggest a greater suspicion rate and early screening that necessary when evaluating young patients with common symptoms

The outcome of head up tilt test in older adults with typical versus atypical features of syncope

Background: Syncope is usually a benign condition preventable by simple measures. Its diagnosis by history and inexpensive tests like head-up tilt table (HUTT) test save the patient unnecessary expenditure and stress. Objectives: To determine the outcome of head-up tilt test in older adult patients aged 60 years and more who present with typical versus atypical history of syncope, along with a study of the prodromal symptoms, association with comorbid burden, medications, grip strength, and cognitive function. Materials and Methods: An observational study of the patients presenting to the department of geriatrics with a history of neurocardiogenic syncope from May 2017 to October 2017 undergoing HUTT test looked at the association of the type of syncope based on the history and outcome of their HUTT test and association with prodromal symptoms, comorbidities, medications, triggering factors, electrocardiography, and Holter. Conclusions: The HUTT positivity rate for patients with a history of syncope was 31.8% with no association between typical or atypical syncope and HUTT positivity. Dizziness, lightheadedness, blurred vision, and sweating were significantly associated with typical syncope. No comorbidity or medication had an association with syncope or HUTT response but the comorbid burden had a significant association with positive HUTT response.

Cross clamping of the supraceliac aorta is effective for bleeding control in ruptured giant splenic artery pseudoaneurysm when proximal and distal control of the splenic artery is not possible: a case report / O clampeamento da aorta supracelíaca é eficaz no controle de sangramento em pseudoaneurisma gigante roto de artéria esplênica quando o controle proximal e distal da artéria esplênica não é possível - relato de caso

Abstract Splenic artery pseudoaneurysm is the most common of all the visceral artery pseudoaneurysms. Presentation is often variable and the condition demands immediate diagnosis and management because pseudoaneurysm rupture increases morbidity and mortality. It is associated with pancreatitis and other conditions like abdominal trauma, chronic pancreatitis, pseudocyst of the pancreas, liver transplantation, and, rarely, peptic ulcer disease. We present a case of a giant splenic artery pseudoaneurysm measuring 14x8 cm. Proximal and distal control of the vessels could not be achieved during the procedure because of local adhesions and inflammation and it was necessary to cross clamp the supraceliac aorta to control bleeding.

Resumo O pseudoaneurisma de artéria esplênica é o mais comum entre os pseudoaneurismas de artérias viscerais. A apresentação geralmente varia e requer diagnóstico e tratamento imediatos, pois a ruptura do pseudoaneurisma aumenta a morbimortalidade. Esse tipo de pseudoaneurisma está associado à pancreatite e a outras condições, como trauma abdominal, pancreatite crônica, pseudocisto de pâncreas, transplante de fígado e, raramente, úlcera péptica. Apresentamos um caso de pseudoaneurisma gigante de artéria esplênica, com tamanho de 14x8 cm. Durante o procedimento, não foi possível alcançar controle proximal e distal dos vasos devido a aderências locais e inflamação, sendo necessário o clampeamento da aorta supracelíaca para controle do sangramento.

Primary retroperitoneal extraovarian granulosa cell tumor

Extraovarian granulosa cell tumors (GCTs) develop from ectopic gonadal tissue situated along the embryonal route of the genital ridge. Primary retroperitoneal tumors are extremely rare, with an incidence of 02% -06% and 80-85% probability of malignancy. Only eight such case reports have been published previously. We herein, report a rare case of extraovarian retroperitoneal GCT in a 55-year-old woman who presented with intermittent left lumbar region pain of one-year duration. She had a history of hysterectomy and bilateral salpingo-oophorectomy 8 years ago for uterine leiomyoma. Laparotomy revealed a retroperitoneal mass measuring 8cm x 10cm x 20cm in size, solid cystic with areas of necrosis and hemorrhage. The gross features, classical histopathology, and positive immunostaining of the retroperitoneal mass with inhibin, calretinin, PR, WT1 and immunonegativity for EMA were characteristic of adult-type GCT. Excluding any previous history of primary ovarian GCT in this patient, a de-novo retroperitoneal diagnosis was established.

Comparison of clinical efficacy of ropivacaine and lignocaine with adrenaline for implant surgery anesthesia: a split-mouth randomized controlled clinical trial

Background@#The primary indication for using long-acting anesthetics in dentistry is extensive dental procedures that require pulpal anesthesia beyond 90 min and management of postoperative pain. Ropivacaine is an amide local anesthetic that is available at various concentrations with inherent vasoconstrictive properties at low concentrations. Ropivacaine has a 75% greater margin of safety than bupivacaine. Ropivacaine can be a good alternative to bupivacaine as a local anesthetic in dental implant surgery as it provides a longer duration of both pulpal and soft tissue anesthesia after mandibular nerve block and lowers CNS and cardiovascular toxicity.This study aimed to evaluate and compare the clinical efficacy of ropivacaine and lignocaine for implant surgery anesthesia. @*Methods@#Fifteen patients with bilateral edentulous sites indicated for implant placement were recruited for this study. Patients aged 20–60 years of both sexes were randomly recruited. Thirty implant placements were performed in the test and control groups using ropivacaine and lignocaine with adrenaline as local anesthetics, respectively. @*Results@#The results were analyzed statistically. The duration of anesthesia was significantly higher in the test group than in the control group. Ropivacaine was found to be superior to lignocaine in terms of the quality of anesthesia. The comparison of mean visual analog scale scores showed ropivacaine to have better anesthetic and analgesic effects than the control group. @*Conclusion@#Ropivacaine 0.75% provides a significantly longer duration of anesthesia than lignocaine 2% with adrenaline. Ropivacaine 0.75% decreased intraoperative and postoperative analgesia compared to lignocaine 2% with adrenaline. Hence, ropivacaine 0.75% can be used as an alternative to lignocaine in implant surgeries and other intraoral surgical procedures that require a longer duration of anesthesia and analgesia.

Comparison of clinical efficacy of ropivacaine and lignocaine with adrenaline for implant surgery anesthesia: a split-mouth randomized controlled clinical trial

Background@#The primary indication for using long-acting anesthetics in dentistry is extensive dental procedures that require pulpal anesthesia beyond 90 min and management of postoperative pain. Ropivacaine is an amide local anesthetic that is available at various concentrations with inherent vasoconstrictive properties at low concentrations. Ropivacaine has a 75% greater margin of safety than bupivacaine. Ropivacaine can be a good alternative to bupivacaine as a local anesthetic in dental implant surgery as it provides a longer duration of both pulpal and soft tissue anesthesia after mandibular nerve block and lowers CNS and cardiovascular toxicity.This study aimed to evaluate and compare the clinical efficacy of ropivacaine and lignocaine for implant surgery anesthesia. @*Methods@#Fifteen patients with bilateral edentulous sites indicated for implant placement were recruited for this study. Patients aged 20–60 years of both sexes were randomly recruited. Thirty implant placements were performed in the test and control groups using ropivacaine and lignocaine with adrenaline as local anesthetics, respectively. @*Results@#The results were analyzed statistically. The duration of anesthesia was significantly higher in the test group than in the control group. Ropivacaine was found to be superior to lignocaine in terms of the quality of anesthesia. The comparison of mean visual analog scale scores showed ropivacaine to have better anesthetic and analgesic effects than the control group. @*Conclusion@#Ropivacaine 0.75% provides a significantly longer duration of anesthesia than lignocaine 2% with adrenaline. Ropivacaine 0.75% decreased intraoperative and postoperative analgesia compared to lignocaine 2% with adrenaline. Hence, ropivacaine 0.75% can be used as an alternative to lignocaine in implant surgeries and other intraoral surgical procedures that require a longer duration of anesthesia and analgesia.

Study of coagulation profile and platelet indices in pregnancy induced hypertension with special reference to preeclamptic and eclamptic patients

Background: Hypertensive disorders of pregnancy affect about 10% of all pregnant women around the world. A variety of haematological abnormalities may occur in women with Pregnancy Induced Hypertension (PIH), thrombocytopenia being the most common. There is also a definite exaggeration of the hypercoagulable state during PIH. A strong relationship exists between the two most important causes of maternal mortality and morbidity worldwide: Preeclampsia and Post-partum hemorrhage. The aim of this study was to find out the changes that occur in the coagulation profile and platelet indices in PIH as compared to that in normal pregnancy and if they can be used as a reliable indicator of the onset and severity of Preeclampsia and eclampsia.Methods: This was a hospital based analytical prospective study carried out in R. G. Kar Medical College, between January 2017 to June 2018 on 120 patients with PIH. The study parameters included Platelet count, Platelet Distribution Width (PDW), Mean Platelet Volume (MPV), Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT).Results: The results showed significant decrease in platelet count in preeclampsia and eclampsia patients when compared to normotensive patients. Also, there was significant increase in MPV and PDW in preeclamptic and eclamptic patients. Coagulation profile showed increased PT and APTT both in preeclamptic and eclamptic patients with eclamptic patients having significantly higher APTT than other groups.Conclusions: Thus, authors came to the conclusion that platelet indices and coagulation profile can be used as a reliable early indicator of onset and severity of preeclampsia and eclampsia.

A study on surgical complications of peptic ulcer disease: a prospective study at a tertiary care center

Background: Peptic ulcer was defined as a disruption of the mucosal integrity of the abdominal esophagus, stomach, duodenum leading to local defect or excavation due to active inflammation. Hospitalizations for peptic ulcer disease (PUD) have decreased since the advent of specific medical therapy & low tachyphylaxis associated with those drugs. This study aims to evaluate the surgical complications of peptic ulcer disease and tested the hypothesis that despite the decrease in hospitalization for PUD, the incidence of elective surgery for PUD during the recent three decades tends to decrease and in contrast, the frequency of emergency surgical interventions for complications of the PUD has remained consistent.Methods: A total of 60 patients operated for complications of PUD, admitted to PES Institute of Medical Sciences, Kuppam, from January 2018 to September 2019. All data that may be potential predictors concerning complications of PUD were prospectively analyzed.Results: In the present study, the most common complication was perforated peptic ulcer (78.3%) followed by Gastric outlet obstruction (15%) and rest bleeding peptic ulcer.Conclusions: Despite the efficacy of modern medical therapy, decreasing the overall PUD hospitalizations, the volume of procedures to treat complications of PUD has not declined.

The conserved aspartate in motif III of b family AdoMet-dependent DNA methyltransferase is important for methylation

S-adenosyl-L-methionine (AdoMet)-dependent methyltransferases (MTases) are involved in diverse cellularfunctions. These enzymes show little sequence conservation but have a conserved structural fold. The DNAMTases have characteristic motifs that are involved in AdoMet binding, DNA target recognition and catalysis.Motif III of these MTases have a highly conserved acidic residue, often an aspartate, whose functionalsignificance is not clear. Here, we report a mutational study of the residue in the b family MTase of the Type IIIrestriction-modification enzyme EcoP15I. Replacement of this residue by alanine affects its methylationactivity. We propose that this residue contributes to the affinity of the enzyme for AdoMet. Analysis of thestructures of DNA, RNA and protein MTases reveal that the acidic residue is conserved in all of them, andinteracts with N6 of the adenine moiety of AdoMet. Interestingly, in the SET-domain protein lysine MTases,which have a fold different from other AdoMet-dependent MTases, N6 of the adenine moiety is hydrogenbonded to the main chain carbonyl group of the histidine residue of the highly conserved motif III. Our studyreveals the evolutionary conservation of a carbonyl group in DNA, RNA and protein AdoMet-dependentMTases for specific interaction by hydrogen bond with AdoMet, despite the lack of overall sequenceconservation

Primary hydatid cyst of the pterygomandibular region: an unusual cyst, location and case report

Hydatid disease is a zoonotic infection in humans. The disease is endemic in some parts of the world, including Africa, Australia, and Asia, where cattle grazing is common; the disease is spread by an enteric route following the consumption of food contaminated with the eggs of the parasite. Failure to identify this parasite results in delayed diagnosis and increased morbidity to the patient. Upon diagnosis, every possible step should be taken, both surgical and medical, to prevent anaphylactic reactions from the cystic fluid. Postsurgical long-term follow up along with periodical ultrasonography of the liver and computed tomography scan of the abdomen is essential to rule out possible recurrence.

Primary hydatid cyst of the pterygomandibular region: an unusual cyst, location and case report

Hydatid disease is a zoonotic infection in humans. The disease is endemic in some parts of the world, including Africa, Australia, and Asia, where cattle grazing is common; the disease is spread by an enteric route following the consumption of food contaminated with the eggs of the parasite. Failure to identify this parasite results in delayed diagnosis and increased morbidity to the patient. Upon diagnosis, every possible step should be taken, both surgical and medical, to prevent anaphylactic reactions from the cystic fluid. Postsurgical long-term follow up along with periodical ultrasonography of the liver and computed tomography scan of the abdomen is essential to rule out possible recurrence.