A case report of a pediatric patient with Hirschsprung’s disease

The objective is to describe an uncommon case of Hirschsprung's disease (HD), also called congenital megacolon. The lack of neuronal ganglion cells from the submucosal and muscular nerve plexuses throughout a segment of varied length characterizes HD. Approx 94% of HD cases are diagnosed below the age of 5 years. A 3 years old male patient was admitted to the male surgery ward under a pediatric surgeon with the chief complaints of chronic constipation since birth with a history of delayed passage of meconium. The patient was diagnosed with a case of HD at the age of 1 year for which he was operated on colostomy was performed with multiple biopsies from narrowed rectosigmoid, from the transitional zone, and from colostomy stoma which confirmed the decision to make colostomy at the ganglionated segment of the colon based on the clinical picture during surgery. Biopsy report of narrowed rectosigmoid segment showed the absence of ganglion cells, while colostomy stoma and dilated proximal colon showed the presence of ganglion cells. The patient underwent a surgical procedure named pull-through surgery for HD, a martin's modification of the Duhamel operation.

Lung cancer in the older population: Interactive effects of angiotensin converting enzyme gene polymorphism (rs 4340 ID) and tobacco addiction in risk assessment

Background: rs4340ID polymorphism of angiotensin-converting enzyme (ACE) correlates with serum ACE levels in many known cancers. This study analyzed ACE rs4340 ID polymorphism in lung cancer (LC) in older patients of North India and correlated it with addiction status. Methods: The study enrolled all subjects aged 60 years and above with 154 LC and 205 healthy controls. Genotyping was done by polymerase chain reaction (PCR) and validated by sequencing of 10% of the sample. Statistical analysis was done by SPSS Statistics 21. Results: Genotype II was observed to have a significant 2.21-fold increased risk of LC as compared to the DD genotype and 3.43-folds enhanced risk with interaction of I allele with tobacco consumption habits as compared to D allele in LC was seen. Conclusion: The risk of LC was higher with II genotype as compared to DD genotype. Interactive effect showed that I allele with tobacco habits may increase the risk of LC.

A cross-sectional study to describe the spectrum of ocular manifestations and risk factors of mucormycosis presenting to a tertiary hospital of East India

Purpose: To report the clinico?demographic profile of rhino?orbito?cerebral mucormycosis (ROCM) in patients during the “second wave” of the COVID?19 pandemic in eastern India, and their ophthalmic manifestations at presentation to our tertiary institute. Methods: Cross?sectional study amongst patients presenting to our center based on their hospital records. Demographic information, history related to COVID?19, records of detailed ocular examination, and microbiological, radiological, and histopathological investigation were entered into an online worksheet and analyzed using SPSS 26.0. Results: A total of 219 patients with ROCM were treated from May to September 2021, and 110 of these had ocular manifestations at presentation (50.2%). The age of patients ranged from 22 to 83 years and the mean ± standard deviation (SD) age was 49.9 ± 12.9 years. Ninety (81.8%) patients had been diagnosed with diabetes mellitus, 31 (34%) had hypertension, and 10 had other comorbidities. The duration between the onset of COVID?19 and mucormycosis symptoms was 0 to 60 days with a mean ± SD interval of 20.9 ± 12.6 days. Fifty?six (50.9%) patients had a history of steroid use. Unrelenting ocular or facial pain was the most common presenting symptom, ptosis was the most common anterior segment manifestation, and ophthalmic artery occlusion was the most common posterior segment manifestation. Conclusion: Our data from eastern India reinforces the relationship between COVID?19, diabetes, corticosteroid use, and ROCM. Knowledge of various presenting anterior and posterior segment manifestations of the disease as described in the present study will guide clinicians to recognize the disease early and make every effort to prevent complications.

Role of amniotic membrane transplantation in treating acute ocular manifestations in Steven–Johnson syndrome and its long-term impact

Background: Steven–Johnson syndrome (SJS) is a serious disorder affecting the skin and mucous membrane, causing multiple flaccid bullae and purpuric rashes with sheet?likeepithelial detachment including the ocular surface. The long?term outcomes following SJS are dismal and manifest as corneal vascularization, lid?wiper keratopathy, and severe dry eyes. The disease course can be modified if amniotic membrane graft is performed at the first week of disease, and the above?said complications can be avoided. This procedure thus not only decreases the morbidity but also improves the quality of life. Purpose: This video discusses the long?term sequelae of SJS which can be modified with timely intervention during the acute stage and thus significantly decreases morbidity. Synopsis: The video demonstrates the simple technique of amniotic membrane transplantation in the acute stage in SJS and its impact in long run. Highlights: There should be a low threshold for doing early amniotic membrane transplantation in patients with SJS with ocular surface involvement. Early intervention can change the disease course and decrease disease morbidity significantly.

Clinico-epidemiologic characteristics of optic neuritis in a tertiary eye centre in Eastern India based on the status of serum aquaporin-4 antibody

Purpose: To elucidate the clinico?epidemiologic characteristics of optic neuritis based on the status of serum aquaporin?4 antibody (AQP4?Ab) in patients with optic neuritis (ON). Methods: Medical records of 106 patients with ON and a follow?up of 3 years were reviewed. For each patient, the following data were extracted: medical history, findings of the ocular examination, brain, orbital or spinal MRI, and serological tests for AQP4. The ON was classified as typical or atypical based on disc examination and improvement in vision after intravenous methylprednisolone (IVMP). The clinical findings (typical or atypical), disease course, and outcomes were analyzed according to the serostatus of the ON. Results: 10 patients ((9.4%) were seropositive for AQP4?Ab; all had atypical ON. 96 patients (91%) were seronegative for AQP4?Ab: 36 atypical ON and 60 typical ON. Profound visual impairment at presentation was seen in all patients. However, at the end of the study period, seropositive and seronegative atypical ON had poor visual outcomes as compared to seronegative typical ON (P = 0.002). Five seropositive and four seronegative patients with atypical ON developed transverse myelitis. Bilateral disease with relapse was more in seropositive patients (80%); however, seronegative with atypical ON also had bilateral presentation and relapse in 42% and 41%, respectively. Conclusion: AQP4?Ab seropositive patients mostly present with atypical features such as bilateral recurrent ON, poor visual outcome, and increased incidence of transverse myelitis. However, atypical clinical features can also be seen in seronegative ON with a poor visual outcome and a recalcitrant course.

Rehabilitation of mechanically ventilated elderly patient with COVID-19 of a dedicated COVID tertiary hospital: a case report

Corona virus disease 2019 (COVID-19), a highly communicable disease caused by severe acute respiratory syndrome-corona virus 2 (SARS-CoV2) which originated in Wuhan, China has affected 213 countries worldwide and has caused an economic crisis. As of August10, 2020, India’s recovery rate is 63%. Most of the critical cases requiring intensive care unit (ICU) management are elderly patients with co-morbidities. The case report is of an elderly, comorbid patient who was intubated and put on a mechanical ventilator. At a time when critical patients on mechanical ventilator hardly survived, this patient survived and was successfully weaned from the ventilator and extubated. The case report emphasizes physical therapy management along with medical management for an elderly SARS CoV2 survivor with co-morbidities, and his journey from the onset of symptoms to being mechanically ventilated to performing his daily activities with minimal discomfort.

Gastric trichobezoar and Rapunzel syndrome: a case report

Giant gastric trichobezoars are unusual form of foreign body found in stomach of mostly young adolescent females which may lead to morbidity and high mortality 30%, if goes unnoticed. These females have history of trichophagia or trichotillomania. This report is of a 12- year old young adolescent female presented with epigastric pain and mass. An exploratory laparotomy with anterior gastrotomy was performed and a giant trichobezoar with a very large tail of 2.5 ft was removed, weighing 2.52 kg. She recovered well and was discharged on 7th post-operative day. Patient was advised for psychiatric follow up.

The influence of family history of cardiovascular disease on blood pressure, waist hip ratio and body mass index in adolescents

Background: Cardiovascular Diseases (CVDs) are the major cause of mortality in the world. Reducing the incidence of CVDs has been a challenge due to the multifactorial risk profile of their origin. Among the non-modifiable risk factor for CVDs family history holds a lot of importance. Objective of the study was to study blood pressure, waist hip ratio and body mass index among adolescents and verify the possible the relation with a family history of cardiovascular disease.Methods: This is a cross-sectional study, which was conducted in 286 school children aged 10 to 19 years, of either sex, from Barabanki. After getting consent from school authorities, children and their parents, a detailed history was taken with a pre-designed proforma. Anthropometric and blood pressure measurements were taken.Results: In the presence of any risk factor of CVDs, 33.9% of the adolescents were overweight/obese, 45.8% had abdominal obesity, 26.3% had elevated systolic BP and 35.6% had elevated diastolic BP. The group with family history of CVDs had significantly higher number of adolescents with obesity and/or hypertension.Conclusions: The present studied showed an important association between family history of CVDs and blood pressure, waist hip ratio and body mass index in adolescents.

Prevalence of Left Ventricular Diastolic Dysfunction in Metabolic Syndrome as Assessed by Echocardiography

Introduction: Metabolic syndrome is a complex disorderwith high socio-economic cost that is considered aworldwide epidemic. It is very common condition Consistinghyperglycemia,central obesity, hypertension and dyslipidemia(low levels of high density lipoprotein cholesterol(HDL-C)and high levels of triglycerides). Current study was done toassess Left Ventricular Diastolic Dysfunction in patients ofMetabolic Syndrome by 2d- Echocardiography.Material and methods: In this study my aim is to find outthe prevalence of left ventricular diastolic dysfunction inmetabolic syndrome and to highlight the importance ofprimary prevention in metabolic syndrome. The Presentstudy is cross-sectional observational study carried out atCSS Hospital Subharti medical college Meerut UP, consistingof 50 patients having metabolic syndrome according to thecriteria of International Diabetic Federation and to look forthere LVDD via 2d- Echocardiography.Results: The left ventricular diastolic dysfunction grade isassociated with the number of characteristics of metabolicsyndrome. Waist circumference, FBS, E/A, IVRT, Decelerationtime, E/e’ showed a statistically significant association (p value<0.01) with the degree of diastolic dysfunction.Conclusion: The current study showed that, metabolicsyndrome group have an associated abnormal left ventriclediastolic performance So the patients with metabolic syndromeshould receive aggressive therapy to avoid occurrence of heartfailure in the future.

Study to determine serum vitamin D levels in patients with congestive heart failure

Background: It was to evaluate the association of serum levels of vitamin D in patients with congestive heart failure.Methods: The present study was conducted in the department of Medicine at Chattrapati Shivaji Subharti Hospital among 100 patients, aged 18 years and above diagnosed as congestive heart failure on the basis of clinical and echocardiographic evidence. Clinical manifestations looked for CHF were: Dyspnea, orthopnea, acute pulmonary edema, cerebral symptoms, cheyne-stokes respiration, cyanosis, sinus tachycardia, raised jugular venous pressure, congestive hepatomegaly and pedal edema. In the present study deficiency/ insufficiency of vitamin D was considered when the presence of levels of 25-hydroxyvitamin D was <30 ng/ml. Laboratory tests performed to diagnose congestive heart failure and serum vitamin D levels were complete blood count, KFT (urea, serum creatinine), serum electrolytes, ECG, chest X ray and echocardiogram. Data were tabulated and examined using the statistical package for Social Sciences Version 22.0.Results: When data was assessed for comparison in relation to NHYA grades and vitamin D levels, it was found to be statistically significant. The Mean±SD scores of serum urea (mg/dL) was found to be 44.7±56.4, 47.3±63.8 and 36.4± 18.3 in whole study sample, vitamin D levels <30 and vitamin D levels >30 respectively with statistically significant difference. The Mean±SD scores of CPK MB (IU/L) was found to be 33.1±20.8 and 18.6±13.3 among the subjects having vitamin D levels <30 and vitamin D levels >30 respectively with statistically significant difference.Conclusions: The results of the present study suggest that low levels of vitamin D may adversely affect the cardiovascular system.

A Study on Actue Kidney Injury in Patients of Dengue Fever in Western Uttar Pradesh Population

Introduction: Dengue fever is a systemic acute viral illnesscaused by Arbo virus from genus flavivirus highly prevalentin the tropics and subtropics, transmitted by Aedes (aegyptiand albopictus) mosquito. Pathogenesis of AKI due to dengueinclude direct action by the virus, hemodynamic instability,rhabdomyolysis, hemolysis and acute glomerular injury.Thisstudy was planned to know the incidence and severity of AKIin patients of Dengue fever.Material and methods: Our study was an observationalretrospective study, done in Subharti Medical College, Deptt.Of Medicine, Meerut between july 2017-December 2018.Medical records of 320 Dengue IgM+ patients admitted duringthis period were studied. Patients were classified into denguefever, dengue hemmorhagic fever, dengue shock syndrome.Results: Out of total 320 patients positive for dengue IgM,48 patients (15%) were found to develop AKI. Out of thetotal 48 patients developing AKI, 26 patients presented withDengue fever, 16 were with Dengue Hemmorhagic Fever and 6presented with dengue shock syndrome. Out of the 48 patientsdiagnosed with AKI, 34 patients fall under KDIGO criteria I, 10patients fall under KDIGO II, 4 patients fall under KDIGO III.Conclusion: Our study concluded that AKI is a major andserious complication,and it is the major cause of Mortality andmorbidity in dengue fever.

A novel, new generation drill coating for osteotomy site preparation

Background: Implant success and survival rate ranges from 93% to 97%; however, failures are not very uncommon. These failures can be caused due to a variety of reasons out of which increased heat during drilling of osteotomies is a major contributor.Aim: The aim of this study was to develop a new generation diamond-coated drill and compare the thermal changes between commercially available drills and the experimental diamond coated drill during implant site preparation in artificial bone. Material and Methods: Three types of drills were selected for the study; Group A (Carbide), Group B (Stainless Steel), and Group C (Experimental). A total of 60 implant site preparations were performed with all the drills in artificial bone using a surgical unit linked to a testing device, in order to standardize implant drilling procedures. Bone temperature variations were recorded when drilling at a depth of 10 mm. A constant irrigation of 50 ml/minute and drilling speed of 800 r.p.m. was maintained. Results: The mean temperature of Group A, Group B, and Group C was 35.57°C, 36.83°C and 34.23°C, respectively. The results were assessed and statistically analyzed using ANOVA test and post hoc Bonferroni test. Statistically significant higher temperatures were obtained with stainless steel drill and carbide drill when compared with the experimental diamond coated drill. (P = 0.000). Conclusions: Diamond coated osteotomy drills have shown promising results in reducing heat generation at the osteotomy. Further studies need to be conducted to maximize the potential use of diamond as components of drills in implant dentistry.

Alteration of cardiovascular autonomic activity in type 2 diabetes mellitus

Background: Diabetes mellitus (DM) is a clinical syndrome characterized by hyperglycaemia due to absolute or relative insulin deficiency. Cardiovascular autonomic neuropathy (CAN) invokes potentially life-threatening outcomes especially in poorly controlled diabetic patients. This study was to evaluate the prevalence of CAN in diabetic patients and its relationship with QTc interval.Methods: This observational study of two year duration was included total 123 patients of more than 30 (thirty) years and up to 60 (sixty) years of age who were presented with diabetic mellitus (DM) those were evaluated for CAN using four distinct clinical tests-Resting heart rate (RHR), test for orthostatic hypotension (OH), hand gripping test (HGT) and QTc interval on ECG. Data were analyzed with statistical package for social sciences (SPSS), version 23.Results: The mean age of all 103 studied patients was 48.94±8.69 years; Mostly patients belong to 50-60 years of age and the majority was males (69.0%). Out of 103 72.8% patients were reported with CAN (51 males and 24 females) and without CAN were 27.2.0% (20 males and 8 females), 36% of patients of Definite Parasympathetic neuropathy, 25% Normal and 20% of Sympathetic neuropathic patients. HbA1c level increases the danger of CAN also. QTc interval is a reliable indicator for the presence of CAN.Conclusions: Duration of diabetes is directly proportional to the prevalence of CAN. Various cardiac autonomic function tests detect CAN.

To Study the Prevalence of Thyroid Dysfunction in Patients of Type II Diabetes Mellitus

Introduction: Diabetes mellitus (DM) and thyroid dysfunction(TD) are the two most common endocrine disorders in clinicalpractice. The unrecognized TD may adversely affect themetabolic control and add more risk to an already predisposingscenario for cardiovascular diseases. TMaterial and methods: 100 patients with T2DM were selectedfrom the Outpatient department and admitted in Inpatientdepartment of Medicine in Subharti Medical College Meerut,participated in the study. Thyroid dysfunction was classifiedas Subclinical hypothyroidism (SCH) was defined as TSH- 4.5to 10 mIU/ml with normal FT4. Overt hypothyroidism-TSH>10 mIU/ml with low FT4. Hyperthyroidism- <0.45 mIU/ml TSH with raised FT4 Subclinical hyperthyroidism- <0.45mIU/ml TSH with normal FT4.Result: The prevalence of Thyroid Dysfunction in all diabeticpatients was 24%.function was 24% (16% had subclinicalhypothyroidism, 6% of patients had overthypothyroidism and only 2% of patients had overthyperthyroidismConclusion: Our study emphasizes the need to checkTSH levels in all type 2 diabetic patients, as subclinicalhypothyroidism was most prevalent thyroid dysfunction inpatients with diabetes.

To Study Serum Testosterone Levels in Metabolic Syndrome

Introduction: Metabolic syndrome (Metabolic syndrome)is a complex disorder with high socioeconomic cost that isconsidered a worldwide epidemic. Current research aimed tostudy serum testosterone levels in metabolic syndrome.Material and methods: The present study was ProspectiveObservational study carried out at CSS Hospital, SubhartiMedical College Meerut U.P. 100 patients of metabolicsyndrome were included in the study who fulfilled the IDFcriteria of metabolic syndrome these patients underwentgenral examination, anthropometry,systemic examination,bmi was calculated, different investigation (Fasting LipidProfile, Serum Testosterone Levels,HBA1C, blood sugarlevels). Descriptive analysis of the collected data was done.Correlation of serum testosterone with various componentsof metabolic syndrome was studied using SPSS software tocalculate the level of significanceResults: This study confirmed the high prevalence of lowtestosterone levels in male patients with metabolic syndrome.The total number of patients who had BMI of more than 35 kg/m2, were 18 and all those had low levels of testosterone whichis significant (p value<0.001). The total number of patientswho had triglyceride level of >150, were 80 and all those hadlow levels of testosterone which is significant (p value<0.001).The total number of patients with low testosterone levels inwhom HbA1C was more than 7.5%, were 68. Patients withnormal level of testosterone were 32 in whom HbA1C was6.5-7.5% which is significant (p value<0.001).Conclusion: This study confirmed the high prevalence of lowtestosterone levels in male patients with metabolic syndrome.Multiple associations and predictors of low testosterone levelswere identified by evaluating different demographic, clinicaland other variables.

Exploring Neuropsychiatric Interphase in Perinatal Period – A Case Series

Perinatal period spans from conception till one-year post-partum. Pregnancy and post-partum ischaracterised by significant biological changes in a woman’s body including changes in blood pressure,blood volume, coagulability of blood and changes in immunity causing onset or relapse of certain medicaland neurological conditions, which can face diagnostic and treatment challenges during this period. We aimto present a series of 3 cases which presented with psychiatric symptoms but on further evaluation werefound to have neurological diagnosis – Cavernous Venous Thrombosis [CVT], Posterior ReversibleEncephalopathy Syndrome [PRES] & Tuberculoma.

Assessing the nicotine content of smoked and smokeless forms of Tobacco Available in Bhopal

Abuse of tobacco, such as drug and alcohol abuse, is a worldwide public health problem. Once a person is addicted to nicotine, quitting smoking is difficult. A measure of the addictive potential of tobacco products is the amount of nicotine available from them. The present study is an attempt to assess the nicotine content of tobacco products available in Bhopal. Aims: This study aims to assess the nicotine content of some popular brands of smoked (cigarettes and bidis) and chewed forms (pan masalas containing tobacco) of tobacco available in Bhopal. Settings and Design: This was an in vitro cross-sectional study. Subjects and Methods: Six brands of cigarettes (filtered), six brands of bidis, and six brands of chewed tobacco (pan masalas) were used for the study. The methodology published by Association of Official Analytical Chemists was followed, and reagents conforming to American Chemical Society specifications were used. Statistical Analysis Used: One-way ANOVA, Bonferroni post hoc test. Results: The mean nicotine levels for cigarettes, bidis, and chewed tobacco were 7.84 ± 5.10, 16.86 ± 5.66, and 16.30 ± 3.33, respectively. The differences in the mean scores were compared using one-way ANOVA and were found to be statistically significant with F = 6.636 and P = 0.009. Bonferroni post hoc test assessed the difference in mean nicotine content among the groups indicating that the difference between cigarettes versus bidis and cigarette versus chewed tobacco was significant with P = 0.016 and 0.024, respectively. Conclusions: Bidis had the highest content of nicotine, followed by chewed tobacco (pan masalas) and cigarettes.

Analysis of Functional Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction using Quadrupled Semitendinosus and Gracilis Autograft - A Two Year Prospective study

Background: The knee joint is frequently involved in sports injuries, road traffic accidents and during daily living activities. Anterior cruciate ligament is a very commonly involved ligament in these injuries. More and more cases of ACL tear are being diagnosed nowadays due to the increasing awareness among orthopaedic surgeon about importance of knee ligament injuries and also increasing availability of MRI as diagnostic tool. Materials & Methods: The prospective study is conducted in Department of Orthopaedics, J.LN. Medical College and Attached Group of Hospitals, Ajmer from November 2014 to November 2016. All young and middle-aged patients presenting with unilateral knee complaints and history of trauma to the knee were evaluated by a thorough general and local clinical examination of the knee. In a relaxed patient and in supine position, the uninjured knee is examined first to establish reference values after which the affected knee is examined. Results: The age of the patients ranged from 15-45 years with the mean age of  27.51 years.  37.1% of the patients in our study were in the age group of  20-25 years. The total of 20 cases (57.1%) of the right knees were involved and 15 cases (42.9%) of the left knee were involved in the study. The ratio of right knee to left knee involved in ACL injury was 1.33:1. After clinical, radiological and Arthroscopic examination we found that 51.4% (18 cases) patients had no associated  injuries. Whereas rest 49.6% cases have associated meniscal injury (MM and LM or both). Conclusion: ACL reconstruction using single stranded quadrupled semitendinosus and gracilis tendon autograft provide an intrinsically stable knee with full range of motion without any pain and with restoration of power.

Otogenic Intracranial Complications - A Case Series

Background: Intracranial complications of otogenic origin is now a rarity. Advent of antibiotics are both blessings if used intelligently and curse if used indiscriminately especially by quacks. Antibiotic resistance and cross resistance have given adverse results. Methods: A total of twenty cases were studied in the Department of ENT at Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh Results: Maximum number of cases belonged to 10 to 20 years age group, i.e eight cases (40%) followed by six cases (30%) in the age group greater than 30 years, four cases (20%) in 20 to 30 years age group, and 2 cases (10%) below 10 years. Males were affected more than females in the ratio of 4:1. The commonest presenting symptom was otorrhea, headache, fever and hearing loss. About half of the patients had vomiting, some had vertigo, otalgia and one patient had facial weakness. Conclusions: Almost all the intracranial complications encountered were intensively and meticulously treated by medical and surgical exercise which gave excellent results with collective team approach.

Unilateral hemorrhagic maculopathy: An uncommon manifestation of hand, foot, and mouth disease.

Hand, foot, and mouth disease (HFD) is a common systemic infection occurring in childhood or immunocompromised adults caused by enteroviruses, the most common being coxsackievirus A16 and enterovirus 71. It is characterized by maculopapular eruptions over the hands and feet and ulcerative stomatitis. Ocular involvement is a rare complication and commonly manifests as inflammatory macular pathology. We report a case of HFD in an immunocompetent adult male with unilateral ocular involvement presenting as hemorrhagic maculopathy and its management with complete anatomical and functional recovery.