Comparison of Multisystem Inflammatory Syndrome (MIS-C) and Dengue in Hospitalized Children

Objective Multisystem infammatory syndrome (MIS-C) in children is a febrile illness that has overlapping presentation with other locally prevalent illnesses. Clinicolaboratory profle of children admitted with MIS-C and dengue were compared to understand their presentation at the outset. Methods This was a retrospective study of children?12 y admitted with MIS-C (WHO defnition) or laboratory-confrmed dengue between August 2020 and January 2021 at a tertiary center in North India. Results A total of 84 children (MIS-C - 40; dengue - 44) were included. The mean (SD) age [83.5 (39) vs. 91.6 (35) mo] was comparable. Rash (72.5% vs. 22.7%), conjunctival injection (60% vs. 2.3%), oral mucocutaneous changes (27.5% vs. 0) and gallop rhythm (15% vs. 0) were seen more frequently with MIS-C, while petechiae [29.5% vs. 7.5%], myalgia (38.6% vs. 10%), headache (22.7% vs. 2.5%), and hepatomegaly (68.2% vs. 27.5%) were more common with dengue. Children with MIS-C had signifcantly higher C-reactive protein (124 vs. 3.2 mg/L) and interleukin 6 (95.3 vs. 20.7 ng/mL), while those with dengue had higher hemoglobin (12 vs. 10.2 g/dL) lower mean platelet count (26 vs. 140× 109 /L), and greater elevation in aspartate (607 vs. 44 IU/L) and alanine (235.5 vs. 56 IU/L) aminotransferases. The hospital stay was longer with MIS-C; however, PICU stay and mortality were comparable. Conclusion In hospitalized children with acute febrile illness, the presence of mucocutaneous features and highly elevated CRP could distinguish MIS-C from dengue. The presence of petechiae, hepatomegaly, and hemoconcentration may favor a diagnosis of dengue.

Delivering a female with missing cervix: a case report

Authors received a case in our casualty, 26 years old, G2P1L1, with full term pregnancy, spontaneous conception, previous normal vaginal delivery, with labour pain. On evaluation, she was having uterine contraction, fetal heart rate normal, vitally stable, with no cervix on per speculum and per vaginal examination, with solid globular mass per rectum. She was shifted to emergency operation theatre with provisional diagnosis of uterine rupture or rectal perforation or pelvic mass. After delivering a live baby, uterus was intact, but there was an impacted mass in pouch of Douglas, it was a twisted ovarian mass, sent for histopathology examination. Post-operative period was uneventful, and patient was discharged with healthy baby with corrected pelvic anatomy.

Prevention of wound infection: a new technique

Background: Caesarean delivery is a major obstetrical surgical procedure aiming to save the lives of mothers and fetuses. Caesarean sections have a 5 to 20-fold greater chance of getting an infection compared with women who give birth vaginally. These infections can be in the organs within the pelvis, around the surgical incision. Microorganisms isolated from surgical site infection (SSI) were mostly from skin and vaginal flora. The most effective SSI prevention strategies involve a multi-faceted approach including protocols exercised before, during, and after surgery to reduce exposure and susceptibility to pathogens.Methods: It was a case control study conducted in our hospital on caesarean patients. Total 240 patients were recruited for study, divided into cases (DDT group) and control (SDT group). Demographic data collected and follow till 30 days of surgery. SSIs patients identified and treated.Results: Out of total 240 patients, mean age SDT, DDT and total patients were 28.46, 28.6 and 28.3 years respectively. Maximum numbers of cases were among multigravida (gravidity) and lower and lower-middle class (socioeconomic status). SSIs patients were seen mostly in SDT group, which was statistically significant. Among SSIs patient maximum numbers of patients were seen in age group of 18-22 years, primigravida and lower socioeconomic class. After their diagnosis most of the patients were treated with resuturing.Conclusions: SSI is common complication after caesarean section; it can be prevented by increasing the hygienic condition in laboring patients. Authors newer method can be a future option for maintaining the intraoperative hygiene.

Study of incidence and clinical presentation of tubercular abdominal emergencies

Background: Tuberculosis is a common surgical problem in our community. Emergency surgery is usually required and surgical procedure depends upon the location and extent of the disease. Objective of the study was to determine the incidence of abdominal emergencies due to tuberculosis.Methods: This observational study involved 300 patients with abdominal tuberculosis admitted either as a case of acute of subacute abdominal emergencies and tract in Lal Lajpath Rai hospital Kanpur, Uttar Pradesh, India, and associated hospitals. Data was entered into Excel worksheet and analyzed using SPSS version 16.0. Detailed data of each patient was entered on a Microsoft excel. Data were presented in number and percentages.Results: The maximum number of cases were in third decade of life, age group 21-30. There were 120 males and 180 females. Male to female ratio was 1:1.5. Most of cases not having evidence of tuberculosis. History of pulmonary tuberculosis and abdominal tuberculosis were observed in 25% and 13% of the total cases. Abdominal pain was the commonest symptoms. Generalized pain was present in 136 cases and localized pain was present in 154 cases. 186 cases were presented as subacute intestinal obstruction and 114 cases patients were presented as acute abdomen.Conclusions: Acute abdominal condition is one of the most frequent emergencies, early diagnosis with prompt treatment is essential for a promising prognosis.

Surgical management and post-operative complications in abdominal tuberculosis patients

Background: Abdominal tuberculosis is a diagnostic and therapeutic challenge in resource limited countries. The vague clinical presentation is a barrier to early diagnosis. Aim of the study was to highlight the role of operative procedures and post-operative complications in patients suffering from abdominal tuberculosis.Methods: This is a descriptive study of abdominal tuberculosis cases, which were operated in the Department of Surgery, Lal Lajpath Rai hospital Kanpur, Uttar Pradesh, India, and associated hospitals. Informed and written consent was obtained from each patient prior to commencement of the study. Detailed data of each patient was entered on a Microsoft excel. Data were presented in number and percentages.Results: Most of the patient’s lumps were present in right ileac fosa, 70.37% followed by lymph node mass. Rolled omentum and appendicular showed minimum percentage of cases. In operative finding on exploratory laparotomy, the most common site of involvement was ileocaecal, and less commonly involved site in abdomen tuberculosis are duodenum and appendix. Surgical procedures, intestinal resection in the form of right hemicolectomy (21 cases), small bowel resection (58 cases). Appendicectomies were done only in 3 cases. Post-operative complications were found in 64 cases. Most of the complication developed in patients those were operated in emergency.Conclusions: Most of the surgeons were preferred conservative surgery rather than extensive resection of the active lesion. Commonest post-operative complication was broncho pulmonary complication.

Comparison of Intrathecal Clonidine and Fentanyl as Adjuvant to Hyperbaric Bupivacaine in Spinal Anaesthesia for Lower Limb Orthopedic Surgery: An Hospital Based Study

Background: There are various adjuvant used with hyperbaricbupivacaine to prolong the effect of spinal anesthesia butcommonly used fentanyl and clonidine. The present study wasundertaken to compare clonidine and fentanyl as adjuvant inspinal anesthesia in terms of time to onset of sensory andmotor blockade, duration of sensory and motor blockade andduration of postoperative analgesia and complications.Methods: The present study was undertaken in thedepartment of Anaesthesia, Government Medical College,Barmer, Rajasthan, India with primary aim to compare durationof postoperative analgesia. A total of 80 patients were enrolledin the present study. Ethical approval was obtained frominstitutional ethical committee and written consent wasobtained from all the patients. Complete demographic details ofall the patients were obtained. All the results were recorded inMicrosoft excel sheet and were analyzed by SPSS software.Results: In our study we found that time for first dose ofrescue analgesic was delayed in Group C (492.32 ± 17.32min) compared to Group F (418.80 ± 19.68min) which wasstatistically significant (P < 0.0001). Duration of sensory blockin Group C was 146.17 ± 19.42 min compared to 128.24 ±18.68min in Group F and Duration of motor block was 190.12 ±25.13 min in Group C in comparison to 176.18 ± 23.54 min in.

A Study of Supraclavicular Brachial Plexus Block by Paresthesia Technique Success Rate and Complications: An Hospital Based Study

Background: The advantage of regional anaesthesia overgeneral anaesthesia are many and well documented. Brachialplexus can be blocked by various methods includingparesthesia technique, nerve stimulation technique and ultrasound guided. The present study was undertaken forassessing time taken to perform block, Successful blockade,complication of supraclavicular brachial plexus block byparesthesia technique.Methods: The present study was undertaken in thedepartment of Anaesthesia, Government Medical College,Barmer, Rajasthan, India with aim of assessing success rateand Complications of brachial plexus block. A total of 100patients were enrolled in the present study. Ethical approvalwas obtained from institutional ethical committee and writtenconsent was obtained from all the patients after explaining indetail of the entire research process. Complete demographicdetails of all the patients were obtained. All the results wererecorded in Microsoft excel sheet and were analyzed by SPSSsoftware.Results: Mean time to perform block was 5.35 minutes andsuccesfull blockade in 92% patients, in 6% patient’s partialblockade and in 2% patient’s complete failure of block.Incidence of complications were vessels puncture 8 % patientsand pneumothorax 1% patients.Conclusion: Supraclavicular brachial plexus block byparesthesia technique is an easy and relatively safe procedurefor the upper limb surgeries below mid shaft of humerus withfew complications and provide good post-operative analgesia.

Technology- Can it Emancipate the Void in India s Mental Healthcare Delivery?

Mobile application-based delivery of mental health awareness programs may help in reducing the knowledge gap in mental healthcare in India. Apps can be used to educate our community about mental health first aid protocols. Apps have shown effectiveness in high-income settings, but they suffer from lack of applicability in low resource scenarios due to challenges of availability of apps in local vernaculars and digital illiteracy. We wanted to determine the potential of technology usage in mental healthcare awareness. We also wanted to explore the acceptability and willingness of caregivers in using mobile based mental health apps.METHODSA cross-sectional quantitative survey was conducted in outpatient setting of Dr. Bhimrao Ambedkar Memorial Hospital, Raipur, in which a semi structured questionnaire was provided electronically to collect data. A total of 120 participants, including 60 caregivers of mentally ill patients and rest 60 caregivers of patients suffering from diseases other than mental illness were included in the study. All 120 participants were included for data calculation. Data obtained was analysed statistically, using Cross Tab Analysis which includes chi-square and Cramer’s V with the help of SPSS (16th) version.RESULTSOut of 120 participants, 85 (70.83%) use smart phone with internet facility. 34 (28.33%) participants already use internet as their primary source of health-related information. 42 (35%) cases and 30 (25%) controls were keen to learn about Mental Health First Aid (MHFA) protocols. Those who had a mentally ill patient in their family were more likely to use a MHFA learning App (Pearson chi square = 11.528; df = 4; p = 0.02 < 0.05; Cramer’s V = 0.031; p= >0.021). There was no significant difference in both the groups’ eagerness to help their loved ones after learning MHFA protocols. Lack of knowledge and awareness and unavailability of an appropriate app were significant barriers.CONCLUSIONSThe study looks into the scope and limitations of implementing a mobile technology-based intervention for low resource setting. Handholding of caregivers and frequent encouragement from treating doctors might significantly help in technology adoption and in surmounting the apprehension related to using technology. The scope of delivering mental health services through technology is immense.

Solid and liquid state characterization of tetrahydrocurcumin using XRPD, FT-IR, DSC, TGA, LC-MS, GC-MS, and NMR and its biological activities / 药物分析学报

Tetrahydrocurcumin (THC) is one of the major metabolites of curcumin (CUR), an ancient bioactive natural polyphenolic compound. This research article describes both the solid and liquid state charac-terization of THC using advanced spectroscopic and thermo-analytical techniques. Anti-inflammatory, anti-oxidant, and neuroprotective activities of THC were investigated using in vitro cell lines. Liquid chromatography-mass spectrometry analysis revealed that our sample comprised 95.15％ THC, 0.51％ tetrahydrodemethoxycurcumin (THDC), 3.40％ hexahydrocurcumin, and 0.94％ octahydrocurcumin. Gas chromatography-mass spectrometry analysis indicated the presence of 96.68％ THC and 3.32％ THDC. THC in solution existed as keto-enol tautomers in three different forms at different retention time, but the enol form was found to be dominant, which was also supported by nuclear magnetic resonance analysis. THC was thermally stable up to 335.55 ℃. THC exhibited more suppression of cytokines (TNF-α, IL-1β, and MIP-1α) than CUR in a concentration-dependent manner in mouse splenocytes, while NK-cell and phagocytosis activity was increased in macrophages. THC showed a significant reduction of free radicals (LPO) along with improved antioxidant enzymes (SOD and catalase) and increased free radical scav-enging activity against ABTS+ radicals in HepG2 cells. THC displayed higher protection capability than CUR from oxidative stress and neuronal damage by improving cell viability against H2O2 induced HepG2 cells and MPP+ induced SH-SY5Y cells, respectively, in a concentration-dependent manner. Thus, a variation of the biological activities of THC might rely on its keto-enol form and the presence of other THC analogs as impurities. The present study could be advantageous for further research on THC for better understanding its physicochemical properties and biological variation.

Assessment of Total Intravenous Anaesthesia in Laparoscopic Surgery: A Hospital Based Prospective Study

Background: Total Intravenous Anaesthesia (TIVA) iscommonly applied during gynecological laparoscopic surgery.Hence; the present study was undertaken for assessingefficacy of Total Intravenous Anaesthesia in LaparoscopicSurgery.Materials & Methods: A total of 30 patients scheduled toundergo laparoscopic cholecystectomy (LC) were enrolled inthe present study. Pre-anaesthetic checkup were done.Solutions of propofol containing different concentrations ofsufentanil were prepared. All the hemodynamic parameterswere recorded intra-operatively. Separate recording of the timeduration required for rescue analgesia was done. Prevalenceof postoperative complications was done. All the results wererecorded and analyzed by SPSS software.Results: Mean age of the patients of the present study was41.7 years. There were 22 females and 8 males in the presentstudy. Mean time to rescue analgesia was 159.15 minutes.Only two patients exhibited nausea and Vomiting.Conclusion: In patients undergoing LC, Total IntravenousAnaesthesia (TIVA) through sufentanil mixed in propofoldelivers adequate anesthesia.

To Evaluate the Diagnostic Yield of Transbronchial Needle Aspiration in Cases of Lung Cancers and Mediastinal Masses or Adenopathy

Background: A great deal of interest in transbronchial needlespiration (TBNA) lies in its utility as a staging tool in patientswith bronchogenic carcinoma. The aim of this study toevaluated the diagnostic yield of TBNA in cases of lungcancers and mediastinal masses or adenopathy.Materials & Methods: The study was carried out and datawere gathered in a prospective fashion and all the data werereviewed retrospectively. Samples were collected from allpatients bronchial washings (BW), brush biopsy (BB), EBB,and TBNA. All TBNA specimens were sent for cytologicevaluation without ROSE as per recommended guidelines.Results: The mean age of studied cases was 58.07 years. Thecommon radiological presentation on x-ray chest was masslesions in 76.66%, mediastinal widening 60%, consolidation26.66% and SPN 3.33% of cases. The diagnostic yield ofvarious bronchoscopic procedure were 27% by BW, 47% byBB, 60% by EBB, 87% by TBNA.Conclusion: We conclude that the overall diagnostic yield offlexible bronchoscopy procedure is increased in patients withEML or SPD by the addition of TBNA. The TBNA is a safeprocedure that should be routinely used to increase diagnosticyield in patients with EML or SPD. In cases of SPD, TBNAshould be considered the procedure of choice.

Evaluation of Efficacy of Different Identification Tests to Distinguish Cerebrospinal Fluid from Local Anaesthetic Solution: A Comparative Study

Background: Local anaesthetics (LAs) are used clinically for anaesthesia and analgesia either following surgery or for management of other acute and chronic pain conditions; they only last a few hours. Various methods have been mentioned in the past literature for differentiating the CSF and the local anaesthetic solutions. Hence; we planned the present study to check and compare the efficacy of simple identifications tests to distinguish local anesthetic solutions from CSF. Materials & Methods: We planned the present study to compare the efficacy of simple identifications tests to distinguish local anesthetic solutions from CSF. We involved five experienced anesthetists for the present study. Both the anesthetics were asked to identify 0.1 ml sample of bupivacaine and mock CSF (tap water) by each of four physicochemical characteristics based on criteria: Temperature, pH, Presence of glucose, and Turbidity when mixed with thiopentone. The anesthetics involved in the present study were unaware of the results. All the results were recorded on excel sheet and were analyzed by SPSS software. Results: The two test solutions were identified conveniently together with the four physiochemical tests. However; the anesthetics were not able to identify and differentiate the solutions clearly with individual tests. Conclusion: Anesthetist should be accustomed with different physicochemical methods available for differentiating between CSF and local anaesthetic solution. However; no single test appears to have complete reliability. Therefore, combinations of tests must be used.

In-depth investigation on physicochemical and thermal properties of magnesium (II) gluconate using spectroscopic and thermoanalytical techniques / 药物分析学报

Magnesium gluconate is a classical organometallic pharmaceutical compound used for the prevention and treatment of hypomagnesemia as a source of magnesium ion. The present research described the in-depth study on solid state properties viz. physicochemical and thermal properties of magnesium gluconate using sophisticated analytical techniques like Powder X-ray diffraction (PXRD), particle size analysis ( PSA), Fourier transform infrared (FT-IR) spectrometry, ultraviolet–visible (UV–Vis) spectroscopy, thermogravimetric analysis (TGA)/differential thermogravimetric analysis (DTG), and differential scanning calorimetry (DSC). Magnesium gluconate was found to be crystalline in nature along with the crystallite size ranging from 14.10 to 47.35 nm. The particle size distribution was at d(0.1)=6.552 μm, d(0.5)=38.299 μm, d(0.9)=173.712 μm and D(4,3)=67.122 μm along with the specific surface area of 0.372 m2/g. The wavelength for the maximum absorbance was at 198.0 nm. Magnesium gluconate exhibited 88.51% weight loss with three stages of thermal degradation process up to 895.18 ℃ from room temperature. The TGA/DTG thermograms of the analyte indicated that magnesium gluconate was thermally stable up to around 165 ℃. Consequently, the melting temperature of magnesium gluconate was found to be 169.90 ℃ along with the enthalpy of fusion of 308.7 J/g. Thus, the authors conclude that the achieved results from this study are very useful in pharmaceutical and nutraceutical industries for the identification, characterization and qualitative analysis of magnesium gluconate for preformulation studies and also for developing magnesium gluconate based novel formulation.

In-depth investigation on physicochemical and thermal properties of magnesium (II) gluconate using spectroscopic and thermoanalytical techniques / 药物分析学报

Magnesium gluconate is a classical organometallic pharmaceutical compound used for the prevention and treatment of hypomagnesemia as a source of magnesium ion. The present research described the in-depth study on solid state properties viz. physicochemical and thermal properties of magnesium gluconate using sophisticated analytical techniques like Powder X-ray diffraction (PXRD), particle size analysis ( PSA), Fourier transform infrared (FT-IR) spectrometry, ultraviolet–visible (UV–Vis) spectroscopy, thermogravimetric analysis (TGA)/differential thermogravimetric analysis (DTG), and differential scanning calorimetry (DSC). Magnesium gluconate was found to be crystalline in nature along with the crystallite size ranging from 14.10 to 47.35 nm. The particle size distribution was at d(0.1)=6.552 μm, d(0.5)=38.299 μm, d(0.9)=173.712 μm and D(4,3)=67.122 μm along with the specific surface area of 0.372 m2/g. The wavelength for the maximum absorbance was at 198.0 nm. Magnesium gluconate exhibited 88.51% weight loss with three stages of thermal degradation process up to 895.18 ℃ from room temperature. The TGA/DTG thermograms of the analyte indicated that magnesium gluconate was thermally stable up to around 165 ℃. Consequently, the melting temperature of magnesium gluconate was found to be 169.90 ℃ along with the enthalpy of fusion of 308.7 J/g. Thus, the authors conclude that the achieved results from this study are very useful in pharmaceutical and nutraceutical industries for the identification, characterization and qualitative analysis of magnesium gluconate for preformulation studies and also for developing magnesium gluconate based novel formulation.

Rifabutin reduces systemic exposure of an antimalarial drug 97/78 upon co- administration in rats：anin-vivo & in-vitro analysis

Objective:To determine the potential drug-drug interactions between anti-malarial candidate 97/78 and anti-tubercular drug rifabutin in-vivo in rats followed byin-vitro investigation of the underlying mechanisms of drug interaction.Methods: Single oral dose study was conducted in male and female rats at 40 mg/kg and 70 mg/kg for 97/78 and rifabutin respectively. Results:It was reported that rifabutin co-administration altered pharmacokinetics of 97/63 (active metabolite of 97/78). A significant decrease was reported in the systemic exposure of 97/63 by a factor of 3-4. The AUC0-last values were (4.03 ± 0.60) and (5.44 ± 1.15) μg?h?mL-1 upon 97/78 administration alone, while the values were decreased to (1.13 ± 0.10) and (1.23 ± 1.13) μg?h?mL-1 upon rifabutin co-administration in male and female rats respectively. Statistically significant differences were also reported in Cmaxand Tmax values upon rifabutin co-administration.In-vitro drug metabolism study in rat liver microsomes has shown that the metabolism of 97/63 was increased by 10%-12% upon rifabutin co-incubation. The extent of plasma protein binding of 97/63 was found to be decreased from 54%-55% to 6%-8% upon rifabutin addition.Conclusions:It was concluded that rifabutin co-administration altered PK parameters of 97/63 in SD rats. However, no intersex influences were reported in the interaction pattern. The results obtained in the in-vivo study were well correlated with thein-vitro findings and can further be applied to explore other aspects of potential drug interactions between these two drugs.

Evaluation of cytotoxic and anti-tumor activity of partially purified serine protease isolate from the Indian earthworm Pheretima posthuma

Objective: To isolate, partially purify and evaluate the cytotoxic and antitumor activity of a serine protease from the chosen Indian earthworm Pheretima posthuma.Methods:Whole animal extract was prepared and purified its protein constituents by size and charge based chromatographic separation techniques using Sephadex G-50 and DEAE-Cellulose resin respectively. Average molecular weight of the protein isolate was determined and analyzed for its cytotoxic property against Vero cells in different dilutions (1: 20 and 1: 40) and anti-tumor activity by MTT assay (a colorimetric assay) using breast cancer cell line MCF-7, with tamoxifen as standard.Results:One of the protein constituents after purification was characterized as serine protease by Caseinolytic plate diffusion assay. Average molecular weight of this purified isolate was determined, by SDS-PAGE analysis with standard protein ladder, as of 15 kDa. The performed tests suggested that the 15kDa fraction has potent cytotoxic activity and satisfactory antitumor activity as well in vitro.Conclusions:Exact molecular mechanism of the cytotoxic and antitumor activities is yet to be explored and currently we are working on ultra-purification and biophysical characterization of this fraction. Further investigation into the mechanism(s) of cytotoxic and antitumor activities at molecular level would be useful in treatment of various classes of cancer and viral infections in future.

Prevalence of oral pre-malignant and malignant lesions at a tertiary level hospital in Allahabad, India.

OBJECTIVE: In a previous article, we reported the prevalence rates of oral mucosal lesions in this hospital from 1990-2001. This study was planned to study the spectrum of potentially malignant and malignant oral lesions in Allahabad, North India in the subsequent years till 2007 and to assess change in pattern of prevalence, if any. MATERIALS AND METHODS: This is a single institutional retrospective study in and around Allahabad from 1990 to 2007. Data was collected year wise with reference to age, sex, site involved and histopathological findings. RESULTS: 1,151 oral biopsies were reviewed. Of these, 365 biopsies were benign, 344 were potentially malignant and 442 were malignant. The buccal mucosa was the most frequently involved site in benign and premalignant lesions, however in malignant lesions, the tongue was most common site. Oral submucous fibrosis constituted the highest number of patients in premalignant group, while in malignant group, squamous cell carcinoma was most prevalent. CONCLUSION: This study showed that potentially malignant and malignant oral lesions were widespread in the patients visiting the hospital in this region.