Etude descriptive des mouvements anormaux en neurologie en milieu hospitalier universitaire au nord du Bénin / Descriptive study of the movement disorders in neurology department at the university hospital in northern Benin

Introduction : Il n'y a aucune donnée publiée sur les mouvements anormaux (MA) au Bénin. Objectif : Etudier la fréquence, les caractéristiques cliniques et évolutifs des MA au CHUD-B/A au nord-Bénin en 2020. Matériel et méthodes : Il s'agissait d'une étude transversale descriptive avec collecte de données sur 5 ans (1er juillet 2015 - 30 juin 2020) en neurologie au CHUD/B à Parakou au Nord-Bénin. Le diagnostic et la classification des MA a été fait par un neurologue selon les critères cliniques du Consensus Statement of International Parkinson and Movements Disorders Society (MDS), et les critères révisés de Jinnah 2014 pour la dystonie. Les autres mouvements hyperkinétiques sont retenus selon les critères de Reich 2010 et les critères de Allen 2003 pour le syndrome des jambes sans repos (SJSR). Résultats : 2250 patients ont été inclus. L'âge moyen des patients MA au diagnostic était de 52,57 ± 20,77ans [1-80ans]. L'âge moyen au début des symptômes était de 49,16 ± 20,85ans [1-80ans]. Le sex-ratio était de 2,58. La fréquence des MA dans le service était de 5,73% (129/2250) et 6,68% (117/1805) en consultation ambulatoire. Les MA identifiés étaient : tremblement (72,09%), akinésie-parkinsonisme (41,08%), dystonie (7,75%), chorée (6,2%), myoclonie (3,1%), dyskinésie (2,33%), ballisme (2,33%), athétose (0,78%), akathisie (0,78%) et le SJSR (0,78%). Le parkinsonisme représentait 2,36% (53cas). Les causes des MA étaient dégénératives (27,91%), idiopathiques (27,13%), vasculaires (13,95%), iatrogènes (11,63%). Le tremblement essentiel 57,14% (28cas) touchait surtout les sujets entre 25-60 ans et n'était pas associé à l'âge (p=0,795) ni aux antécédents familiaux (p=0,417). L'évolution des MA était marquée par leur amélioration partielle 33%, une rémission complète 10,85%, le décès 7,75%. Conclusion : Les MA sont fréquents en Neurologie au CHUD/B-A. Une prise en charge optimale est nécessaire pour améliorer la qualité de vie des patients.

Introduction: There are no published data on movement disorders in Benin. Objective: We aimed to study the descriptive epidemiology, the clinical spectrums and the evolution of MD in the university hospital center of Parakou (CHUD-B/A) in northern Benin in 2020. Material and methods: It was a descriptive cross-sectional study with data collection over 5 years from 07/01/2015 to 06/30/2020 in the neurology department of CHUD-B/A. Diagnosis and classifications of MD was made by a neurologist according to clinical criteria of the Consensus Statement of International Parkinson and Movements Disorders Society (MDS), Jinnah 2014 revised criteria for dystonia, Reich 2010 for other hyperkinetic MD and Allen 2003 criteria for restless legs syndrome (RLS). Statistical analysis was made by Epidata Analysis software. Results: 2250 patients were included. The mean age of patients with MD at diagnosis was 52.57 ± 20.77years with extremes of 1 to 80 years. The mean age at onset of symptoms was 49.16 ± 20.85years [1-80years]. The sex ratio was 2.58. The frequency of MD in the department was 5.73% (129/2250) and 6.68% (117/1805) in outpatients. The MD identified were: tremor 72.09%, akinesia and parkinsonism 41.08%, dystonia 7.75%, chorea 6.2%, myoclonus 3.1%, dyskinesia 2.33%, ballism 2.33%, athetosis 0.78%, akathisia 0.78% and RLS 0.78%. Parkinsonism accounted for 2.36% (53cases). The causes of MD were degenerative (27.91%), idiopathic (27.13%), vascular (13.95%), iatrogenic (11.63%). Essential tremor (28cases) affected patients between 25-60years (57.14%). Evolution was marked by partial improvement (33%), complete remission (10.85%), and death (7.75%). Conclusion: MD are common at CHUD-B/A. Optimal management is necessary to improve the quality of life of patients.

Histological risk score and its role in predicting recurrence in early-stage oral squamous cell carcinomas

Context: Oral squamous cell carcinoma (OSCC) comprises more than 90% of oral cancers and is the most common carcinoma affecting the oral cavity. Early stage T1/T2 OSCC have a heterogeneous prognosis and a significant number of patients develop loco regional recurrence (LRR) and have reduced disease free survival (DFS) with increased disease related mortality. Aims and Objectives: To assess the impact of the three parameters used in Brandwein-Gensler risk model along with lympho-vascular invasion (LVI), depth of invasion (DOI) and lymph node metastases in predicting LRR in early stage OSCC. Materials and Methods: This was a retrospective study on early stage T1/2 OSCC patients over a period of 2 years who received treatment by surgical resection and had follow-up data. LRR was assessed based on recurrence of OSCC at the initial site or in regional lymph nodes. Results: Out of 1135 OSCC cases during our study period a total of 207 cases befitted our inclusion criteria. Recurrence was noted in 113 (54.6%) cases. Univariate analysis identified LVI (P < 0.00001), DOI (P < 0.00001), nodal involvement (P < 0.00001), worst pattern of invasion (WPOI) (P < 0.00001), lymphocytic host response (LHR) (P = 0.004), perineural invasion (PNI) (P = 0.012) as strong statistically significant risk factors for LRR. Conclusion: Adequate assessment of simple parameters on routine H and E by incorporating Brandwein-Gensler histological risk scoring model at the initial presentation can help prognosticate and predict LRR and select patients for post-surgical adjuvant therapy.

A pharmacoeconomic study on cost variation of dyslipidemic drugs available in Indian market

Background: Dyslipidemic drugs are widely prescribed drugs in atherosclerosis, as it is a chronic illness the long term need of this medication creates a financial burden on the patient, especially with patients of low socioeconomic status. Considering this government of India established Jan Aushadhi medical store with a view to provide cheaper generic medicines, so that a good patient compliance is achieved. Aims and Objectives: The aim of the study was to analyze the cost variation of the dyslipidemic drugs available in Indian market under generic and various brand names manufactured by different pharmaceutical industries. Materials and Methods: This was a cross-sectional study conducted to analyze the cost variation of dyslipidemic drugs available in different formulations in our Indian market. The information on cost of each drug with its dosage and formulation was obtained from “Current index of medical specialties” October 2021–January 2022 India and from Jan Aushadhi Price list W.E.F October 2015. Cost ratio and percentage variation among different strength and formulation in dyslipidemic drugs were calculated. Results: The highest cost difference was seen between the minimum cost brand of simvastatin 20 mg tab with its generic drug cost (142.8). Lowest cost differences between minimum brand cost and generic drug was observed for atorvastatin 10 mg tab (17.48). Conclusion: Knowledge about wide cost difference between branded and Jan Aushadhi dyslipidemic drugs helps clinicians to select budget friendly drugs for patients with low socioeconomic status.

Effects of Abacus Training on Auditory Spatial Maturation in Children with Normal Hearing

Abstract Introduction The spatial auditory system, though developed at birth, attains functional maturity in the late childhood (12 years). Spatial changes during childhood affect navigation in the environment and source segregation. Accommodation of a new skill through learning, especially during childhood, can expedite this process. Objective To explore the auditory spatial benefits of abacus training on psychoacoustic metrics in children. The study also aimed to identify the most sensitive metric to abacus training related changes in spatial processing, and utilize this metric for a detailed spatial error profiling. Methods A standard group comparison analysis with 90 participants divided into three groups: I: children with abacus training (C-AT); II: children with no training (C-UT); III: adults with no training (A-UT). The groups underwent a series of psychoacoustic tests, such as interaural time difference (ITD), interaural level difference (ILD), and virtual auditory space identification (VASI), as well as perceptual tests such as the Kannada version of the speech, spatial, and quality questionnaire (K-SSQ). Results Significant group differences were observed in the multivariate analysis of variance (MANOVA) and post-hoc tests, with the C-AT group showing significantly lower ILD scores (p = 0.01) and significantly higher VASI scores (p < 0.001) compared to the CUT group, which is indicative of better spatial processing abilities in the former group. The discriminant function (DF) analyses showed that the VASI was the most sensitive metric for training-related changes, based on which elaborate error analyses were performed. Conclusions Despite the physiological limits of the immature neural framework, the performance of the C-AT group was equivalent to that of untrained adults on psychoacoustic tests, which is reflective of the positive role of abacus training in expediting auditory spatial maturation.

A rare case of giant mucinous cystadenocarcinoma of the right ovary with metastatic deposits and Brenner tumor in the left ovary

Ovarian cancer is the second most common gynecological malignancy. Mucinous tumor accounts for 3% of ovarian tumors and is a challenging task for a surgical pathologist. Association of Brenner tumor, a subtype of epithelial malignancy is a rare entity reported in the literature. Herein, we report a unique case of a 57-years old post-menopausal woman who presented with progressive abdominal distention for 3 years and constipation for 1 year. Clinically, it was suspected as a case of complex ovarian cyst and the patient underwent staging laparotomy. Intraoperatively, a giant mucinous cystadenocarcinoma of the right ovary with deposits in the pouch of Douglas, omentum, umbilical, and the sub-umbilical region was found along with a benign Brenner tumor of the left ovary.

ATTRACTION OF HONEYBEES TO CUCUMBER WITH BEE ATTRACTANTS

In this study, The usage of bee attracts like Bee-Q and Fruit Boost™ in the pollination of Cucumber was evaluated. The bee visitations on target crop ?owers were made for two weeks, followed by estimation of yield parameters. The different concentrations of Bee-Q and Fruit boost™ was evaluated to understand the honeybee visitation pattern of the target crop for improving pollination ef?cacy. The observations indicate that, Bee-Q at 12.5 g/l and Fruit boost at 0.5 ml/l of Cucumber plots meagerly attracted a number of bee foragers than the control plots. In addition, the plots sprayed with bee attractants marginally enhanced the fruits/plant, length and diameter fruits. The present investigation suggests that the bee attractants increases certain amount of bee visitation, in turn, leads to increase in fruits/plant, length and diameter of fruits on Cucumber

Protease inhibitors as a potential agent against visceral Leishmaniasis: A review to inspire future study

Abstract Leishmaniasis is transmitted by sandfly which carries the intracellular protozoa in their midgut. Among visceral, cutaneous and mucocutaneous leishmaniasis, visceral type that is caused by Leishmania donovani is the most lethal one. Findings of leishmanial structure and species took place in 19th century and was initiated by Donovan. Leishmaniasis is still a major concern of health issues in many endemic countries in Asia, Africa, the Americas, and the Mediterranean region. Worldwide1.5-2 million new cases of cutaneous leishmaniasis and 500,000 cases of visceral leishmaniasis are reported each year. Leishmaniasis is endemic in nearly 90 countries worldwide and close to 12 million new cases of leishmaniasis are reported worldwide annually. Studies on antileishmanial drug development is of major concern as leishmaniasis are the second largest parasitic killer in the world and the available drugs are either toxic or costly. The major surface GP63 protease, also known as Zinc- metalloproteases present on the surface of leishmanial promastigotes, can be targeted for drug development. Protease inhibitors targeting such surface proteases show promising results. Different protease inhibitors have been isolated from marine actinobacteria against many infectious diseases. Metabolites produced by these actinobacteria may have greater importance for the discovery and development of new antileishmanial drugs. Hence, this review discusses the background, current situation, treatment, and protease inhibitors from marine actinobacteria for drug development against GP63 molecules.

Trachéotomie chirurgicale chez l'enfant au centre hospitalier universitaire de Bouaké à propos de 32 cas / Surgical tracheotomy in children at the university hospital center of Bouake about 32 cases

Objectif : déterminer les indications de la trachéotomie chirurgicale chez l'enfant, décrire la technique et les suites opératoires. Matériel et méthode : il s'agit d'une étude descriptive rétrospective portant sur les trachéotomies pédiatriques réalisées au CHU de Bouaké de janvier 2016 à décembre 2022. Les indications de la trachéotomie, la technique opératoire et l'évolution ont été étudiées. Le test exact de Fisher a été utilisé pour évaluer le lien entre le motif de la trachéotomie et les pathologies au seuil α de 5%. Résultats : pendant la période d'étude, 32 enfants ont été trachéotomisés. Leur âge variait entre 9 mois et 15 ans avec un âge moyen de 7,2 ans. Il s'agissait de 22 garçons et 10 filles. L'impossibilité d'intuber le patient (65,62%) et la dyspnée laryngée sévère (25%) constituaient les motifs de la trachéotomie. Les corps étrangers laryngo-trachéaux et la papillomatose laryngée représentaient respectivement 37,5% et 21,87% des pathologies. Nous n'avons pas noté de lien significatif entre le motif de la trachéotomie et les pathologies (p=1,000). L'intervention a été réalisée sous sédation dans 78,12% des cas. L'ouverture trachéale était en forme de « H ¼ et de siège sous-isthmique. Les suites opératoires étaient simples chez 93,75% des patients. La décanulation a été effective dans 24 cas (75%). Conclusion : les principaux motifs de la trachéotomie dans notre expérience sont l'impossibilité d'intuber le patient et la dyspnée laryngée sévère. Les pathologies étaient dominées par les corps étrangers laryngo-trachéaux et la papillomatose laryngée. Les suites opératoires étaient généralement satisfaisantes.

Objective: to determine the indications for surgical tracheotomy in children, to describe the technique and the postoperative course. Material and method: This is a retrospective descriptive study of pediatric tracheotomies performed at the Bouaké University Hospital from January 2016 to December 2022. The indications for tracheotomy, the operating technique and the evolution were studied. Fisher's exact test was used to assess the link between the reason for the tracheotomy and the pathologies at the α threshold of 5%. Results: during the study period, 32 children were tracheotomized. Their age varied between 9 months and 15 years with an average age of 7.2 years. They were 22 boys and 10 girls. The impossibility of intubating the patient (65.62%) and severe laryngeal dyspnea (25%) were the reasons for the tracheotomy. Laryngo-tracheal foreign bodies and laryngeal papillomatosis accounted for 37.5% and 21.87% of pathologies respectively. We did not note any significant link between the reason for the tracheotomy and the pathologies (p=1,000). The intervention was performed under sedation in 78.12% of cases. The tracheal opening was "H" shaped and sub-isthmic. The postoperative course was simple in 93.75% of patients. Decanulation was effective in 24 cases (75%). Conclusion: the main reasons for tracheotomy in our experience are the impossibility of intubating the patient and severe laryngeal dyspnea. The pathologies were dominated by laryngo-tracheal foreign bodies and laryngeal papillomatosis. The postoperative course was generally satisfactory

Hairdressers in Johannesburg: knowledge, attitudes and practices regarding occupational health

Introduction: Hairdressers are exposed to hazardous chemicals in haircare products, which can cause adverse respiratory, skin, and reproductive effects. The incidence of these effects can be reduced with good occupational health and safety (OHS) knowledge, attitudes, and practices (KAP). Objective: The objective of the study was to assess Johannesburg hairdressers' knowledge, attitudes, and practices towards occupational health and safety. Methods: Three hundred and eighty-three hairdressers were recruited into this crosssectional study. They were categorised into employees/wage earners (earning a salary or wage, n = 151), or business owners (self-employed, n = 232). Data were collected using an interviewer-administered questionnaire. The data were analysed using Statistical Package for Social Sciences (SPSS) version 26. Frequency tables were generated and chi-square tests were used to test differences between KAP amongst business owners and wage earners. Results: Most of the study participant were female (n = 237, 61.9%). A higher proportion of business owners than wage earners knew that hairdressing was hazardous to their health, in general (n = 44, 29.1% and n = 120, 51.7%, respectively), and with regard to specific health risks such as asthma, cancer, and skin diseases. However, more of the wage earners than the business owners had good attitudes towards the wearing of personal protective equipment (PPE) such as gloves, (n = 143, 94.7% and n = 210, 90.5%, respectively). Overall, wage earners practised better OHS than business owners, e.g. 67.5% (n = 102) and 55.2% (n = 128) reported that they wore gloves, respectively. Conclusion: Wage earners had poorer OHS knowledge than those who owned or operated hairdressing salons. Both had good attitudes towards OHS, but self-employed hairdressers had poorer OHS practices. Training, including workshops and seminars, is needed to improve KAP regarding OHS amongst all hairdressers, regardless of their employment status.

A Cross Sectional Study Among Information Technology Professionals of Vishakhapattanam City to Study the Prevalence of Musculoskeletal Work Related Disorders

Background: The Information technology has revolu?onized many changes throughout the society, and also in bringing up the economic growth of the country.IT professionals are prone to various job-related complaints and symptoms which can be reduced or eliminated by using proper ergonomics. The present study was carried out to study the prevalence of Musculoskeletal disorders among the Informa?on technology (IT) professionals and to determine the factors associated with musculoskeletal problems. Objec?ves:1.To study the prevalence of Musculoskeletal disorders among the Informa?on Technology (IT) professionals. 2. To determine the factors associated with Musculoskeletal disorders among IT Professionals. Methodology: A cross-sec?onal study was done among 400 Informa?on technology professionals of selected IT companies of Visakhapatnam city using mul?stage sampling technique. Structured Interview schedule was taken to collect socio-demographic, personal and working details of employees. Standardised Nordic Musculoskeletal ques?onnaire was used to assess the work-related musculoskeletal symptoms in rela?on to various body regions during last 12 months and last 1 week. Results:The overall musculoskeletal disorders among IT professionals was 74% of which lower back (56.7%) is the most common body region affected in the last 12 months followed by neck (43%), shoulder (28.2%), wrist/hand (8.5%), elbow (5.7%), knee (4%) and ankle (3.7%). Conclusions: The study concludes that, prevalence of work-related health problems among IT professionals are of concern. Work related musculoskeletal problems were widely reported and it was observed that, individuals who have regular physical ac?vity are less prone to Musculoskeletal disorders (MSD).

Role Of "Aardram Mission" In Delivering Public Health Care Services In The State

“Mission Aardram” synonymously can be called as pillar of Kerala model of Development as it has been implemented for the provision of wellbeing of the citizen. Developing nations are facing issues related to the health care offered by the nation to its public hence in turn affect its human development index (HDI). Life Expectancy Index, Education Index and Gross National Income index are the different indicators of HDI which comes from the different dimensions, say, Long and healthy life, knowledge and a decent standard of living respectively. Mission Aardram is concentrating more on the first dimension of HDI, i.e.; Long and healthy Life. In order to keep its people healthy, the state of Kerala has taken an initiative called “Mission Aardram” as part of “Nava Kerala Karma Padhathi”. The Government of Kerala has implemented such a Novel scheme to provide good health care to its people by transforming all Primary Health Centres (PHC) into Family Health Centres (FHC) as the first stage health delivery point, then they intend to strengthen the system by offering five kinds of services, namely, Promotive services, Preventive Services, Palliative services, Rehabilitative services and Curative services. It is mentioned by the Institute of Medicine (IOM) that Mission Aardram has the main six characteristics that should have in any good quality health care system. As per the word of IOM if a health care system is said to be of good quality if and only if the system has Patient safety, Effectiveness, Efficiency, Patient-centered focus, Timely Referral Care and equity in treatment. Hence it is important to evaluate the role of Mission Aardram in delivering public health care by analyzing the above-mentioned factors.

Knowledge and practice towards breast self-examination among accredited social health activists (ASHA) in the rural field practice area of a government medical college in north coastal Andhra Pradesh.

Background: Breast cancer is the most frequent cancer in the world, and it is the main cause of death and morbidity in Indian women. Breast self-examination (BSE) is a routine exam that can detect 40% of breast abnormalities and involves two key components that is looking and feeling. Women should learn what is normal for them, so that they can recognize any changes immediately. Aim & objectives: 1) To assess Knowledge and Practice about Breast Self-Examination. 2) To assess awareness about warning signs of Breast cancer. Methodology: A Descriptive cross-sectional study was conducted among 55 Accredited Social Health Activists (ASHAs) in the month of January 2021 in the Rural field practice area of Rural Health Centre (RHC) attached to the Department of Community Medicine, Government Medical College, Visakhapatnam. A predesigned, semi structured questionnaire was used to assess the knowledge and practice of BSE. Data was entered in MS Excel and analysed using SPSS Version 17. Chi square test was applied to find out the statistical associations if any between categorical variables. Results: In the present study only 1.8% of the ASHA workers were found to have good knowledge. 41.8% and 56.3% had average and poor knowledge respectively about BSE. Out of 55 ASHA workers, 39 (71%) have heard of BSE, 25.4% were practicing regularly and 14.5% of them were practicing correct method. Conclusion: The Knowledge and Practice of BSE among ASHA workers was observed to be inadequate which points out the need for training programs to educate them.

Determination of phenolic compounds and antioxidant potential of aqueous extracts of Curcuma longa L., Piper nigrum L. and Cuminum cyminum: an experimental and a quantum-mechanical study / Determinação de compostos fenólicos e potencial antioxidante dos extratos aquosos de Curcuma longa L., Piper nigrum L. e Cuminum cyminum: um estudo experimental e quanto-mecânico

Objectives: Evaluation of phenolic compounds and antioxidant activities of aqueous extracts of C. longa, P. nigrum and C. cyminum. In addition to proposing a quantum-mechanical model to evaluate the antioxidant activity. Methods: The aqueous extracts were prepared using roots of the Curcuma longa L., seeds of the Piper nigrum L. and seeds of Cuminum cyminum. The extracts were subjected to tests to detect and quantify phenolic compounds and to assess their antioxidant capacity by different methods. Furthermore, to investigate the electronic nature of the antioxidant activity of the main compounds present in these extracts, frontier molecular orbitals (FMOs) were obtained by the DFT/B3LYP/6-31G(d,p) level of theory. Results: After statistical analysis of the results, a greater number of phenolic compounds and better antioxidant activity was identified in the aqueous extracts of cumin (C. cyminum) in all three assays performed, when compared to the other extracts tested. The theoretical model based on the Pietro method is in agreement with the experimental results. Conclusion: This study has an innovative proposal with the trivial antioxidant activity combined with theoretical quantum-mechanical calculations that can serve to reduce costs and time and to predict the antioxidant activity of subsequent studies.

Objetivos: avaliar os compostos fenólicos e atividades antioxidantes dos extratos aquosos de C. longa, P. nigrum e C. cyminum bem como propor um modelo quanto-mecânico para avaliar a atividade antioxidante. Métodos: os extratos aquosos foram preparados por meio da utilização de raízes de Curcuma longa L., sementes de Piper nigrum L. e sementes de Cuminum cyminum. Os extratos foram submetidos a ensaios para detectar e quantificar compostos fenólicos e atividade antioxidante por diferentes métodos. Além disso, com objetivo de investigar a natureza eletrônica da atividade antioxidante dos principais compostos presentes nesses extratos, orbitais moleculares de fronteira (OMFs) foram obtidos pelo nível de teoria DFT/B3LYP/6-31G(d,p). Resultados: após as análises estatísticas dos resultados, a maior quantidade de compostos fenólicos com maior atividade antioxidante foi identificada no extrato aquoso do cominho (C. cyminum) em todos os ensaios realizados, quando comparados com os outros extratos testados. O modelo teórico baseado no método de Pietro está concordante com os resultados experimentais. Conclusão: este estudo possui uma proposta inovadora com a atividade antioxidante trivial combinada com cálculos quanto-mecânicos que podem servir para reduzir custos e tempo para predizer a atividade antioxidante de estudos futuros.

Role of Jaloukavacharana in Management of Raktharshas (Thrombosed Hemorrhoids)

Arsha's is one among the Astamahagada, and a commonest ano-rectal disease with a wide range of symptoms. It affects all economic groups of the population. In Ayurveda, Arsha's is a growth of Mamsa with obstructs the anal opening. Anatomically anal canal is 51/2 Angula's length. A faulty lifestyle and dietary habits along with occupational and physical stress triggers the pathology of Arsha's. Doshic involvement includes Rakta along with Mamsa dhatu at Rakthavaha Dahmanis of Guda, which forms as Mamsa Ankura. Acharya Susrutha mentioned 4 curative measures for the treatment, they are Bhesaja, Kshara karma, Agni karma, Shastra karma. Hemorrhoids are dilated rectal veins. Thrombosed piles occur where there is high venous pressure, which is associated with severe pain, which hampers their daily routine, thereby they avoid defecation which leads to hardening of stool, constipation and rectal bleeding. The treatment includes the surgical excision of the thrombosed pile mass. A case study of thrombosed pile treated with Jaloukavacharana (leech therapy) has been recorded which has reduced the mass, pain, bleeding per rectum

Comparative study of epidural fentanyl with bupivacaine and epidural tramadol with bupivacaine for postoperative pain management in orthopedic lower limb surgeries

Introduction: Pain is a complex subjective sensation that is difficult to quantify in a repeatable manner. Surgical pain is observed to be more intense post-surgery and then fades in the next 24 h. Epidural anesthesia/analgesia is the most widely used technique for lower limb surgeries because of its good sensory and motor block property, reduces stress response, and maintains sufficient spontaneous respiration and hemodynamic stability. Materials and Methods: The study looked at 100 individuals between the ages of 20 and 60 who underwent elective lower limb surgery and were classified as ASA I and II. The patients were split into two 50-person groups. The adverse effects of nausea, vomiting, respiratory depression, urine retention, and pruritus, as well as the quality and duration of postoperative analgesia, were investigated. The patient was monitored for 48 h after surgery. Results: A total of 100 patients were included in the study, where the least age of the patient was 19 years and the greatest age was 75 years. In group T, maximum patients belong to the age group of 26–35 years, whereas in group F maximum patients belong to the age group of 36–45years. In group T, 41 (82%) were males and 9 (18%) were females. In group F, 37 (74%) were males and 13 (26%) were females. Conclusion: Our findings show that epidural tramadol and epidural fentanyl are equally effective, except for fentanyl’s shorter duration of action. Fentanyl also has a moderate sedative effect, which is beneficial in the postoperative period.

Management of Cervical IVDP with Ayurvedic Interventions- A Case Report

Bones and joint disorders are common in the working age population and are conditions that affect passive (bones, joints) and/or active structures of the body (muscles, tendons, ligaments, peripheral nerves) . A 35 year old moderately built young gentle man working as an IT professional, complains of pain on nape of neck and back of the chest since one year. But however pain started radiating to left upper arm since past 4 months, night starts which apparently effecting sleep. Pain gets aggravated by physical activities like continuous sitting posture and gets relieved by analgesics and sleep at Chondroitin Sulphate. Cervical IVDP, can be considered as Apabahuka or Asthi majjagata vata . He was managed with external and internal medications like cervical traction, Lepanam, physio, Gandharvahasthadi kashayam, Sneha panam done with Gugguluthikthakam ghee, purgation done with Gandharvahasthadi erandam and Nasya done with Anutailam and Ksheerabala tailam

Pulmonary tuberculosis with superadded infection of echinococcus and aspergillus

Pulmonary tuberculosis is one of the most common immunosuppressive infections in India, seldom accompanies other parasitic and fungal infections. In our case, we describe the three coexistent infections and their clinical presentation in a 53-year-old woman. A fibro-cavitary lesion in lung with superadded infections of hydatid cyst and aspergillus which is rare has been elaborated in the present case.

Anaerobes in cardiac infections: A decade experience from the tertiary care center

Purpose: Anaerobic infections are common yet life-threatening. They are being recovered from all sites of the body, including the cardiovascular system. This study was aimed to determine the retrospective analysis on the isolation of anaerobes in cardiovascular samples received for a decade-long duration. It helps in knowing the frequency of isolation of anaerobic causes of cardiovascular infection. Methods: All cardiovascular samples from the department of Cardio-thoracic vascular surgery from January 2010 to December 2020 were studied. Results: Of 601 samples received, predominant samples were vegetations and valvular tissues of 258, followed by 98 samples of pericardial tissues, 92 samples of embolus, 90 samples of blood and post-operative collections, and 63 excised aneurysms and vascular grafts. Of the total, 15 samples grew anaerobes where Clostridium species were the predominant isolates. Clostridioides difficile was isolated in 2 samples. Conclusions: Anaerobes in cardiovascular samples are uncommon yet form a significant cause of morbidity and mortality. Most infections are from the contiguous spread, penetrating trauma, and hematogenous causing endocarditis or valvular infections. These conditions and samples form the seat of infectious focus and clinical suspicion towards the anaerobic cause of these conditions, especially in conventional routine culture-negative samples. Timely diagnosis of anaerobic infections plays a vital role in the good prognostic outcome of patients undergoing cardiothoracic and vascular surgery.

Performance & clinical utility of oropharyngeal versus nasopharyngeal swabs in COVID-19

Background & objectives: The oropharyngeal (OP) and nasopharyngeal (NP) swab samples are the most recommended clinical specimens for detecting SARS-CoV-2 in an individual through the quantitative real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR) method. The primary objective of this study was to compare the performance of NP and OP swabs for the diagnosis of COVID-19 among 2250 concomitant samples (1125 NP + 1125 OP) using rRT-PCR test. Methods: This study was conducted at a tertiary care hospital in southern India. The study compared the specificity and efficacy of the two samples (NP & OP swabs) in 1125 individuals suspected having COVID-19 infection. The rRT-PCR values from all the samples were compared based on gender, age group and viral load. The differences between unmatched proportion and matched proportion were analysed. Agreement between the two methods was assessed using Kappa statistic. Absolute sensitivity, specificity, positive and negative predictive values (PPV and NPV) for OP and NP swabs were analysed. Results: The study identified a fair degree of agreement between OP and NP swabs in diagnosis of COVID-19 (kappa = 0.275, P<0.001). There was also a fair degree of agreement between NP and OP swabs irrespective of gender, age or duration of symptoms. NP swabs had better sensitivity and NPV as compared to OP swabs, however, specificity and PPV were 100 per cent for both. Interpretation & conclusions: The present study showed that both OP and NP swabs had similar sensitivity and specificity for predicting the presence of SARS-CoV-2.

Association between serum netrin-1, netrin-4 and risk of the acute coronary syndrome in patients with type 2 diabetes mellitus-A pilot study

The present study was done to assess the diagnostic utility of serum netrin-1 and netrin-4 for recognising the acute coronary syndrome (ACS) in type 2 diabetes mellitus (T2DM) patients. Forty-two T2DM patients with ACS (Cases) and forty-two T2DM patients without ACS (Controls) were compared. Cases had lower serum netrin-1 and netrin-4 levels than controls and were negatively associated with creatinine kinase-total, creatinine kinase-MB, troponin-T and H-FABP. ROC analysis showed that netrin-1 and netrin-4 had good sensitivity and specificity for ACS prediction in T2DM patients. Serum netrin-1 and netrin-4 levels might be considered complementary markers for ACS diagnosis in T2DM patients.