Beyond the pulse: unusual presentations of Takayasu抯 arteritis

Takayasu抯 arteritis (TA) a.k.a pulseless disease is a chronic inflammatory occlusive thrombo-aortopathy. It is a rare inflammatory disease affecting large arteries, often leading to significant diagnostic challenges, especially when presenting with atypical symptoms. This case report explores a patient, whose primary complaints were chest pain and no neurological or constitutional symptoms, diverging from the common presentations of diminished pulses or limb claudication. Advanced imaging, including CT Aortogram and interventions like cardiac angiography, played a crucial role in detecting vascular inflammation and stenosis, facilitating accurate diagnosis and management. The case underscores the importance of considering Takayasu arteritis in differential diagnoses, even with non-classical presentations. This present case demonstrates rare and unique presentation of TA where patient presents with myocardial infarction and cardiogenic shock and also explains the diagnostic dilemma of TA with such unusual presentation.

Knowledge regarding immunization among mothers of under-five children in Uttarakhand

Background: Immunization is one of the most impactful and cost-effective health investments globally that helps in reducing the burden of infectious diseases keeping children safe. Mothers are the major role players with regard to their children’s immunization. Methods: A descriptive cross-sectional study was conducted to assess knowledge regarding immunization among mothers of under-five children in the Doiwala block of Dehradun, Uttarakhand. A total of one hundred mothers of under-five children were conveniently selected through door-to-door survey. A structured knowledge questionnaire on under-five immunization was administered through the interview technique to assess the knowledge of the mothers. Results: Among 100 mothers of under-five children 13% had poor knowledge, 63% had average knowledge and 24% had good knowledge regarding under-five immunization. There was significant association between age, education status and socioeconomic status of mothers with knowledge score regarding under-five immunization. Conclusions: There is a strong need to increase awareness and knowledge about immunization among children; its benefits and importance. There is also a need to educate people especially mothers regarding harmful consequences of incomplete immunization of children.

EFFECTS OF PLATELET-RICH PLASMA INJECTIONS ON OSTEOARTHRITIC PATIENTS

Objective: Various treatment options are available for knee osteoarthritis such as medical treatment with NSAID, conservative management with platelet-rich plasma (PRP) and corticosteroids. We have done this prospective study to know the use and safety of platelet- rich plasma (PRP) injections in knee osteoarthritis (KOA) patients. We know platelet rich plasma (PRP) clinical and functional outcome in knee osteoarthritis (KOA) by doing this study and using the available literature.Methods: This prospective study consisted of a total number of 96 patients suffering from knee osteoarthritis. Both males and females are included. Intra-articular injection of platelet rich plasma (PRP) was given in sterile conditions and clinical and functional outcomes were analyzed with Western Ontario and McMaster University Arthritis Index (WOMAC), Visual Analogic Scale (VAS), and Knee Society score (KSS). This study is done in a tertiary care institute during the study period. Results: Most patients were females aged>40 years with knee osteoarthritis. The injections of platelet rich plasma (PRP) showed results at three, six and twelve months follow-up showed significantly reduced WOMAC scores, Visual Analogic Scale (VAS) and Knee Society score (KSS). No complications were observed during the follow-up period.Conclusion: The results confirm the efficacy of the PRP injections on Knee osteoarthritis, suggesting that decreasing pain was obtained one month after injection, with the best results observed after 12 months—however, a more extensive study group. Follow-up is required for a prolonged period to assess the efficacy of PRP injection.

Nursing students' perceptions of resilience, social support, and coping strategies during the COVID-19 pandemic: a multi-center study

Background: Resilience found to be an important factor in protecting the nursing students against the stress during coronavirus outbreak. Aim of the study was to evaluate the relationships between resilience and perceived social and organizational support and coping strategies among nursing students. Methods: This web-based survey carried out among nursing undergraduates (n=1017) across the country. Data was collected using self-reported questionnaires in May 2021. Results: Majority of the students had a normal level of resilience, perceived a high level of social and organizational support and used effective coping strategies. Also, the variables of resilience, social support, organization support and coping strategies were positively correlated (p<0.001). While ag e was positively correlated with resilience, younger (t=4.647, p<0.001) and females (t=-0.3620, p<0.001) perceived a higher level of social support than others. Conclusions: The results suggest that strengthening resilience and improving coping skills and social support may promote psychological wellbeing for nursing undergraduates during the coronavirus pandemic.

Performance of Horse Gram [Macrotyloma uniflorum (L.) Verdc] Germplasm for Seed Yield and Its Component Characters

The present investigation was carried out with 78 diverse horse gram [Macrotyloma uniflorum (L.) Verdc] genotypes along with 4 checks during the late Kharif season. Data was recorded on days to 50 percent flowering, days to maturity, plant height, number of branches per plant, pod length, number of seeds per pod, number of pods per plant, pod weight (g), seed yield per plant (g), and 100-seed weight (g). Analysis of variance revealed significant differences among all the genotypes for all the characters studied. A wide range of variations had been observed for all the characters except for the number of seeds per pod. The highest coefficient of variation was observed in the number of pods per plant followed by 100 seed weight and seed yield per plant. The phenotypic coefficients of variation (PCV) were higher than the genotypic coefficient of variation (GCV) for all the traits but the differences were narrow. The highest magnitude of PCV and GCV were recorded for seed yield per plant (g) followed by pod weight (g) indicating a wide range of variation which provides a chance for yield improvement. High heritability coupled with high genetic advance was observed for plant height, number of branches per plant, number of pods per plant, pod weight, seed yield per plant, and 100 seed weight indicating additive gene action and the abundant scope for improvement in these traits through simple selection. This study provides information about the performance of the genotypes and identifies some prominent genotypes. Thirty-three genotypes recorded significantly higher seed yield per plant as compared to the best-performing check. These genotypes were IC 426292, IC 470167, IC 426471, IC 470229, IC 470206, IC 470262, IC 426464, IC 107247, IC 108076, IC 426550, IC 426540, IC 108078, IC 426537, IC 470166, IC 467865, CRHG-1, IC 426539, IC 426478, IC 426524, IC 426549, IC 426522, IC 470170, IC 261278, IC 470188, IC 426535, IC 107222, IC 226533, IC 426574, IC 426523, IC 526965, IC 426571, IC 426517 and IC 426538. These genotypes may be further used for parental selection in breeding programs for the improvement of yield and its attributes in horse gram.

Identifying F. oxysporum Strains Causing Wilt in Southern Indian Chickpeas

Fusarium oxysporum (Schletend: Fr) f. sp. ciceri (Padwick), referred to as Foc, is a soil-borne fungus that poses a constant threat to chickpeas (Cicer arietinum L.) by causing wilt disease. Typical wilt symptoms were observed in chickpea plants collected from 24 different locations across three southern Indian states. The process involved isolating Fusarium species from the roots of these wilted plants, resulting in the identification of various strains exhibiting diverse cultural and morphological characteristics on potato dextrose agar medium. All twenty four isolates were subjected to Koch's postulates using the standard method, which yielded varied responses in terms of disease incidence. After analyzing cultural, morphological, molecular traits, and conducting pathogenicity tests, the fungus was definitively identified as F. oxysporum Schlechtend. Fr. f. sp. ciceri (Padwick) Matuo and K. Sato. Among the 24 isolates tested on the chickpea wilt susceptible cultivar JG-62, one was non-pathogenic with zero percent disease incidence (PDI), while one isolate was highly pathogenic showed 100 percent PDI. Highly pathogenic four isolate was further used for molecular identification with secreted in xylem primers (SIX). Comparative studies of cultural traits and conidial morphology among different isolates revealed variations in growth patterns, pigmentation, sporulation, and the size and structure of macro and micro conidia, as well as chlamydospores.

Role of Genetic Variability and Their Associated Character on Yield Attributing Traits in Castor (Ricinus communis L.) Germplasm Lines

Castor (Ricinus communis L.) is an industrially important non-edible oil seed crop with limited genetic variation. It is consequently important to diversify the genetic base to utilize the diversity. The primary objective of this study was to assess the extent and significance of variability among castor genotypes concerning yield and its associated traits. A study with two hundred germplasm lines along with four checks on genotypes on variability, correlation, and path coefficient was carried out for nine traits. The genotypic coefficient of variation (GCV) and phenotypic coefficient of variation (PCV) values indicated the presence of broad variation for all characters except for days to 50 percent flowering, days to maturity, number of nodes, and oil content. However, high heritability coupled with high genetic advance as percent mean was observed for plant height, days to 50 percent flowering, days to maturity, number of nodes, total length of the primary spike, number of effective spikes, seed weight, and total yield. The character's plant height, number of nodes, total length of the primary spike, number of effective spikes, seed weight, and oil content show a positive significant correlation with the total yield. The path coefficient analysis indicates that the utmost positive direct effect on total yield was exerted by a number of effective spikes per plant. Hence it was concluded that selection for traits total length of the primary spike, number of effective spikes, and 100 seed weight beneficial in yield improvement programs of castor.

Telangana Jonna 1(CSV 41): A High Yielding, Dual Purpose, Potential Sorghum Variety

Aims: The aim of this study was popularize the developed high yielding, dual purpose, potential sorghum variety and its acceptability by the farming community.Study of Design: Randomized Block Design.Place and Duration of Study: The Present study was conducted at Regional Agricultural Research Station, Palem, Nagarkurnool and evaluated across fifteen AICRP centers at national level from 2010 to 2019.Methodology: A high yielding, dual purpose sorghum variety was derived from a cross between SPV-86 x ICSR-89064 through Pedigree method of breeding and subsequently it was evaluated at station level from 2013 – 2015 and also at AICRP system from fifteen centers during 2016 – 2018 for its grain and fodder yield and resistance to pests and diseases and showed superior performance over the three nation checks.Results: Sorghum culture SPV 2437 recorded highest grain and fodder yield of 3179.8 kg ha-1 and15900.2 kg ha-1and yielded +39.25%, +3.86% and +14.88% higher grain yield and +92.48, +13.59, and +8.46 higher fodder yield superiority than checks CSV 17, CSV 20 and CSV-27 and shown 3.67 mean field grade and 4.37 mean threshed grade showing resistant reaction to grain mold disease.Conclusion: The sorghum variety SPV 2437 with higher grain and fodder yield, resistance to pest and disease and good cooking quality as compared to the check varieties was released through central varietal release committee during 2020 for Zone I (Andhra Pradesh, Telangana, Tamil Nadu, Rajasthan and Gujarat states) on the name of Telangana Jonna 1/CSV 41 and gaining its importance across the states for its high potential yield.

Hypertrophic pachymeningitis: a rare manifestation of IgG4 related disease

Hypertrophic pachymeningitis (HP) is a rare form of diffuse inflammatory disease that causes thickening of the dura mater. It can involve the cranial or the spinal dura or both. An increasingly well-known symptom of IgG4-related illness, a fibroinflammatory syndrome that may affect almost any organ, is IgG4-related hypertrophic pachymeningitis (IgG4-RHP). It is estimated that IgG4-RHP may account for a high proportion of cases of hypertrophic pachymeningitis once considered idiopathic. Contrast magnetic resonance imaging (MRI) shows pachymeningeal enhancement. Serum IgG4 levels may be elevated but are normal in most patients. However, most patients have elevated cerebrospinal fluid (CSF) IgG4 index. Hence, CSF IgG4 index could serve as a less invasive diagnostic marker of IgG4-RHP. Confirmation of diagnosis is by meningeal biopsy that shows swirling “storiform” fibrosis with lymphocytic infiltrates, obliterate phlebitis and IgG4 positive plasma cells. This case highlights the diagnostic dilemma of IgG4-RHP as gold standard of diagnosis is meningeal biopsy which has many of its own limitations. CSF IgG4 index could be an alternate option for meningeal biopsy when the procedure is contraindicated or uninformative.

An Interesting Endocrine Cause of Pyrexia of Unknown Origin: A Case Report and Review of Literature

Pyrexia of unknown origin (PUO) is one of the most challenging medical problems. Endocrine causes of PUO are rare. Fever is common in a few endocrine disorders (e.g., thyroid storm, adrenal crisis and pheochromocytoma). However, PUO as the sole presenting feature is very rare with only a few reported cases in the literature. We present the case of a middle-aged male who came to us with PUO, weight loss and loss of appetite. The unusual symptomatology like loss of appetite, altered bowel habits made diagnosis difficult. This case highlights the importance of considering thyroid disorder in the differential diagnosis of PUO. Abnormal thyroid function may be an early clue for diagnosis.

Bioabsorbable screws versus metallic interference screw fixation in anterior cruciate ligament reconstruction using hamstring autograft: comparative analysis of functional outcome

Background: This prospective comparative study aimed to evaluate the functional outcomes of bioabsorbable screws versus titanium interference screws for anterior cruciate ligament (ACL) reconstruction using hamstring autograft. Methods: The study included 30 patients who underwent ACL reconstruction with a quadrupled hamstring graft; 15 were fixed with titanium interference screws and 15 with bioabsorbable screws. The patients were followed up for six months post-surgery. The functional outcomes were evaluated using the Lysholm score. The data were analyzed using SPSS version 22.0. Results: There was no significant difference in the functional outcomes between the two groups at the six-month follow-up. Conclusions: Our study shows that there was no difference in functional outcome whether bioabsorbable or titanium interference screw was used. The success of ACL reconstruction depends on the correct technique used for the surgery, precise placement of graft and rehabilitation methods than on type of graft fixation device used, neither titanium nor bioabsorbable screws.

Bioabsorbable screws versus metallic interference screw fixation in anterior cruciate ligament reconstruction using hamstring autograft: comparative analysis of functional outcome

Background: This prospective comparative study aimed to evaluate the functional outcomes of bioabsorbable screws versus titanium interference screws for anterior cruciate ligament (ACL) reconstruction using hamstring autograft. Methods: The study included 30 patients who underwent ACL reconstruction with a quadrupled hamstring graft; 15 were fixed with titanium interference screws and 15 with bioabsorbable screws. The patients were followed up for six months post-surgery. The functional outcomes were evaluated using the Lysholm score. The data were analyzed using SPSS version 22.0. Results: There was no significant difference in the functional outcomes between the two groups at the six-month follow-up. Conclusions: Our study shows that there was no difference in functional outcome whether bioabsorbable or titanium interference screw was used. The success of ACL reconstruction depends on the correct technique used for the surgery, precise placement of graft and rehabilitation methods than on type of graft fixation device used, neither titanium nor bioabsorbable screws.

Viral Load-based Evaluation of the Sensitivity of Antigen-based Rapid Detection Assay for SARS-CoV-2

Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has become a global public health problem. The real-time reverse transcription-polymerase chain reaction (RT-PCR) is the gold standard test for the detection of SARS-CoV-2. However, the assay requires hours to get the final results. Therefore, antigen-based rapid assays are being used extensively to reduce the time. We have evaluated the performance of the antigen-based rapid test for the detection of SARS-CoV-2 virus in comparison with RT-PCR. Materials and methods: Nasopharyngeal and throat swabs were collected from 366 suspected patients of COVID-19 visiting our institute and subjected to qualitative RT-PCR and antigen-based rapid assays to detect the presence of SARS-CoV-2 virus. The sensitivity and specificity of the antigen-based assay were calculated in comparison with RT-PCR. Results: Compared with RT-PCR, sensitivity and specificity of the antigen-based rapid assay were observed to be 70.5% and 98.6%, respectively, in comparison with RT-PCR. However, the sensitivity of antigen-based rapid assay varied significantly with decreasing viral load. The sensitivity of the rapid antigen assay was equivalent to RT-PCR (23/23, 100%) at a higher viral load (Ct value 15�). In contrast, the antigen assay could only detect 3/21 (14.28%) samples with Ct value >30. Conclusion: The antigen-based assay could assist in the rapid screening of a large population. However, the rapid antigen assay might not detect early stages of infection represented by low viral load. Therefore, the antigen-based assay could not replace RT-PCR testing. The study reiterates that all antigen-based negative tests should be confirmed by RT-PCR.

2D Echocardiographic Findings, NT-ProBNP Levels, and Outcomes in Dyspnoeic Patients: Results from the Pro-BNP Investigation of Dyspnoea in the Emergency Department- a Single Centre Experience

Background: Dyspnoeic in the emergency department with multiple co-morbidities is a diagnostic challenge. Approximately 15-20% of acute dyspneic in the Emergency Department due to ADHF (acute decompensated heart failure) are misdiagnosed. B-type peptide (BNP) and its amino-terminal fragment (NT-proBNP) accurately identify HF in dyspnoeic patients. In the general population with dyspnoea, plasma pro-BNP concentrations are increased in left ventricular dilatation, hypertrophy, systolic dysfunction, or diastolic dysfunction but are unaffected by pulmonary dysfunction. Aims and Objectives: To study the relation between NT pro-BNP & echocardiographic findings in acute dyspnoeic patients, and the relation between NT pro-BNP and In-hospital Mortality. Materials and Methods: Source of data- Patients admitted to the Emergency Room or cardiac intensive care unit with a history of acute dyspnea in a tertiary cardiac care center in south India, meeting inclusion & exclusion criteria, were studied. Results: The study population is predominantly constituted of the elderly population. The most common co-morbid condition was hypertension. The present study uses an NT pro BNP level of 900pg/ml as the cut-off level. 78 patients were positive for the test. Echocardiography showed that 58% had LV systolic dysfunction, 60% had diastolic dysfunction. 42 patients had EF >55%, 10 patients between 55-45%, 33 patients between 44-30% and 15 patients had EF < 30%. Mortality rate was 6% in the whole study population. However, Mortality was seen in only NT pro-BNP positive group it was not statistically significant (p=0.46). Conclusions: NT pro-BNP correlates well with the worsening of LV systolic function; as the EF decreases, NT pro-BNP increases. Increase in NT pro-BNP levels has to be interpreted in the clinical context, and it is not a substitute for echocardiography for assessing cardiac abnormalities and dysfunction.

Dual Clinical Collaborator: A Pragmatic Role of nurses from developing countries

Collaboration is crucial in Professional nursing practice. Nurses act as a liaison between physicians and patients and their family members. Thus, it is vital to define the collaborative role of nurses in developing countries. The authors discuss pragmatic nurses' role by adopting the Dual Clinical Collaborator model to ensure offering the quality of care to their clients. Nursing is a healthcare profession that focuses on the care of individuals and their families to help them recover from illness and maintain optimal health and quality of life.(1) Health Care Professionals (HCPs) work together to provide quality health care and accomplish common goals. As healthcare delivery is becoming more complex, collaboration among healthcare workers and the patient can be a path to improve the quality of healthcare services. According to Walker and Avant's method, the conceptual definition of collaboration in nursing is an intra professional or interprofessional process by which nurses come together and form a team to solve patient care or healthcare system problem with members of the team respectfully sharing knowledge and resources.(2) Thus, collaboration is crucial in everyday professional nursing practice and should be considered a core value of nursing.(3)

Effect of Paribhadra Paneeyakshara in Mutraghata Caused by Benign Prostatic Hyperplasia- A Case Report

Benign Prostatic Hyperplasia is a troublesome disease that bothers the population of ageing men by decreasing their quality of life. It is an abnormal growth involving the submucosal glands of prostate. The disease interferes with the normal daily activities and sleep pattern and hence is a matter of concern to the medical field. The symptoms of Benign Prostatic Hyperplasia closely coincide with the symptoms of Mutraghata (urinary obstruction) explained in Ayurveda. When taking the obstructive pathology into consideration, Paneeyakshara Prayoga (alkali for internal administration) is classically mentioned as a treatment option. This work is a case study on the effect of Paneeyakshara prepared out of Paribhadra (Erythrina indica) which is a drug possessing Vatakaphahara (alleviate Vata and Kapha Dosha) and Shophahara Karma (pacify inflammatory swellings) in Mutraghata caused by Benign Prostatic Hyperplasia. A 66-year-old male who presented with the signs and symptoms of Benign Prostatic Hyperplasia was administered with 500 mg of Paribhadra Paneeyakshara with 1 gram of Guda (jaggery), morning and evening, half an hour before food for a period of 45 days. Assessment was done before and after treatment based on the IPSS (International Prostate Symptom Score) of the American Urological Association and the Ultrasound abdomen findings. The post- interventional assessment showed a lowered IPS Score and reduced USG parameters indicating the efficacy of Paribhadra Paneeyakshara in reducing Mutraghata caused by Benign Prostatic Hyperplasia.

A comparative study of primary cellulitis and its local complications in lower limbs in diabetics and non-diabetics through the new Amit Jain’s staging system from India

Background: The objective of the study was to validate Amit Jain’s staging system for cellulitis in diabetic and non-diabetic lower limbs and to predict the outcomes associated with cellulitis and surgical procedures done in them.Methods: We conducted a prospective study in department of surgery at Raja Rajeswari Medical College and Hospital Bengaluru, India. The study period was from December 2018 to November 2019. Statistical analysis was done using SPSS 22 and R environment ver.3.2.2.Results: A total of 36 patients were included in this study of which 21 were diabetics and were in placed in group A and 15 were non diabetics and placed in group B. 83.3% of the patients were males. 73.3% of non-diabetics had stage 1 cellulitis and 33.3% of diabetics had stage 1 and 2 each. 47.2% of patients underwent debridement and it was significantly common in diabetics (p=0.037) and also it was common in higher stages of cellulitis (p=0.001). 8.3% had amputation in this series. All the major amputations were done in stage 4 cellulitis (p=0.002).Conclusions: In this validation study, it can be seen that cellulitis is common in both diabetics and non-diabetics but it is severe in diabetic patients. Stage 3 was more common in diabetics compared to non-diabetics. Amit Jain’s staging system of cellulitis is a simple, easy, practical, focal classification that guides therapy and predicts amputation.

Primary ileal volvulus: a rare cause of small intestinal obstruction

A 50-year-old lady presented to us in the emergency department with history of acute abdominal pain and vomiting since the past 24 hours. Abdominal examination showed tenderness and guarding in the hypogastrium, lumbar and right iliac fossa region. Initial diagnosis of ruptured appendicitis was considered but exploratory laparotomy gave us an intra-operative surprise. Small bowel volvulus is extremely rare in clinical practice and their symptoms are usually nonspecific. The diagnosis is typically confirmed at surgery most of the time just like in this case. No etiology of this volvulus was found in this patient. Ileal volvulus carries a significant risk of mortality. Awareness of this condition among surgeons will help to reduce the morbidity and mortality associated with this unusual form of intestinal obstruction.

Assessment of knowledge, attitude and practices of universal precautions among medical and nursing students

Background: Universal precautions is an approach to infection control to treat all human blood and certain human body fluids as if they were known to be infectious for HIV, HBV and other bloodborne pathogens. The CDC recommends Standard Precautions for the care of all patients, regardless of their diagnosis or presumed infection status. Health care personals are at risk of being exposed to blood-borne pathogens. The aim of the study to determine the knowledge, attitude and practice of medical and nursing students towards universal precautions.Methods: A cross-sectional survey was carried out at S. S. Institute of Medical Sciences and Research Centre, Davangere, Karnataka. The participants were medical and Nursing undergraduate students. A questionnaire was prepared based on the WHO and CDC guidelines on Universal Precautions and was validated and pre-tested before finalization. Degree of knowledge was ascertained by means of yes-no questions on each item being evaluated.Results: All students were aware of Universal precautions, but soundness of their knowledge is very poor. Compliance in Universal precautions is good to average in nursing students but poor to average in medical students.Conclusions: It can be concluded that interventions to improve Universal precautions among medical students, nursing students urgently needed. So, there is a need for developing strategies to promote the use of Universal precautions which take into account behaviour change and accuracy of knowledge including its integration into practice. Teaching universal precautions early in their curriculum is necessary for better learning and practices during their posting.

Clinicopathological And Radiological Comparison Of Adenomyosis In Hysterectomy Patients - A Retrospective Study

BACKGROUND : Hysterectomy - The most commonly performed gynaecological surgery throughout the worldAIMS AND OBJECTIVES :This study aims at comparing the clinical, radiological and histopathological diagnosis of adenomyosis in hysterectomy patients.MATERIALS AND METHODS : A retrospective study was done on the 120 hysterectomy specimens received from August 2018 – August 2019 at the Pathology department in Ahalia Diabetes hospital. RESULTS AND DISCUSSION :Our study shows 100% of the clinical and radiological cases of adenomyosis and combined leiomyoma with adenomyosis were diagnosed by the histopathological examination.