Role of visual evoked potential as a window to detect functional changes that occur without signs of diabetic retinopathy in fundoscopy: Case series involving symptomatic overt diabetic pregnant women

Diabetic retinopathy (DR) is a microvascular complication associated with diabetes mellitus. Pregnancy is a major risk factor for DR in diabetic women. Recent evidenced suggests that in course of DR functional changes including damage of pre-ganglionic and ganglionic cells in retina precede structural microvascular changes. A number of studies in the past have highlighted the role of pattern visual evoked potential (VEP) in detecting such functional changes. However, the study of VEP changes in diabetic pregnancies remains unexplored. This case series has the objective of exploring VEP changes in symptomatic OVD cases, who had no signs of DR on fundoscopy. We present two cases of overt diabetic women who complaint of straining of eyes, headache, and difficulty in reading during pregnancy. Complete ophthalmic examination was done in both the cases followed by a VEP test. VEP test was done as a part of a research project. The ethical clearance for the project was obtained from the Institute’s Ethics Committee before the commencement of the study. Fundoscopic examination in both cases revealed that the retina was within normal limits with no signs of retinopathy. In Case 1, P100 latency was increased for the left eye and was normal for the right eye during the first visit. While P100 latency was increased for both left and right eye during the second visit. There was a substantial increase in P100 latency for both eyes in second visit as compared to first visit. In Case 2, P100 latency was increased for both left and right eye and amplitude decreased for the left eye. This is a case series consisting of symptomatic overt diabetic pregnant women who had increased P100 latency despite no signs of retinopathy in fundoscopy. The previous studies have reported that multiple follow-ups with ophthalmoscopy may not be cost-effective in diabetic pregnant women. VEP provides a window for detection of early functional changes that may help identify at risk patients for follow-up and early intervention.

Quality of life in patients of low back pain with radiculopathy: A descriptive analytical study from Punjab

Background: Low back pain with radicular symptoms is one of the most prevalent musculoskeletal disorders and leading cause of disability. Radicular back pain can be defined as a diffuse process affecting more than one underlying nerve root that causes pain and depending on the severity of symptoms may cause loss of sensation and motor function. Quality of life (QOL) is a multidimensional patient-based outcome criterion which can be used to describe the impact of health condition on the patient as well as the effects of the treatment. Low back pain interferes with QOL and work performance. Aim and Objectives: To analyze the QOL in patients of low back pain with radiculopathy. Materials and Methods: This descriptive-analytical study was carried out on 364 low back pain patients and healthy people in Government medical college, Patiala, India, from January 2021 to June 2021. We used SF-36 questionnaire to assess QOL, which allows calculating eight different scores (on a scale of 0–100), a physical component scale (PCS), and a mental component scale (MCS) summary. Mean Mental (MCS) and Physical (PCS) component summary scores were assessed and compared with healthy people involved in the study. Overall, a higher PCS and MCS score indicates better QOL. Results: Out of 364 patients enrolled, 311 patients with mean age of 49.1 ± 11.9 years were included for the study. SF-36 was administered and assessed. The result from this questionnaire showed that mean PCS and mean MCS were significantly lower in the low back pain patients compared to the normative population and were statistically significant. Conclusion: Patients of low back pain with radiculopathy have poor QOL compared to normative individuals. Lower QOL in patients necessitates getting early treatment, educating the patient, and rehabilitation. It is vital to give more attention to the QOL of the patient as it is an untouched domain.

Myocardial bridging – Sudden unexpected death of a young girl: A case report

Myocardial bridging (MB) is a relatively uncommon congenital anomaly where a segment of the coronary artery dips inside the myocardium and takes a tunneled course under a bridge of the myocardium. This leads to the compression of the coronary artery during systole resulting in hemodynamic changes and their clinical manifestations. However, it is an incidental finding but can present with multiple complications like myocardial ischemia, infarction, and sudden death, primarily when associated with other risk factors like left ventricular hypertrophy of the heart. Therefore, a careful examination of the heart is essential for evaluating the clinical significance of the MB. Here, we presented a case of a 30-year-old young female who had a sudden death, and her histological examination of the heart showed MB of left anterior descending coronary artery (LAD).

Protocol for developing a surveillance system for surgical site infections

Purpose: Healthcare-associated infections (HCAIs/ HAIs) are the most common adverse occurrences during health care delivery. Across the globe, millions of patients are affected by HAIs annually, with a higher burden and impact in developing nations. a major lacuna in planning preventing protocols is the absence of National Surveillance Systems in most low-middle income countries, which also prevents allocation of resources to the high-priority areas. Among all the HAIs, there is a huge global burden of SSIs, in terms of morbidity, prolonged hospital stays, increased antimicrobial treatment as well as attributable mortality. Method: This manuscript details the process of establishment of an SSI surveillance protocol at a level-1 trauma centre in North India. Result and Conclusion: Surveillance is an essential tool to reduce this burden. It is also an important primary step in recognizing problems and priorities, and it plays a crucial role in identifying risk factors for SSI and to be able to target modifiable risk factors. Therefore, it is imperative to establish reliable systems for surveillance of HAIs, to regularly estimate the actual burden of HAIs, and to use these data for developing indigenous preventive measures, tailored to the country's priorities.

Rapidly reversing bilateral macular edema associated with fluid overload in a young type 1 diabetic

We report a case of sudden onset bilateral diminution of vision in a young lady with type 1 diabetes. She was administered intravenous fluids for correction of diabetic ketoacidosis (DKA) prior to onset of her ocular symptoms. Dramatic resolution of macular edema was noted within a very short period after correction of fluid input–output ratio. Visual acuity was restored to baseline after 3 days without any active ocular intervention.

Prevalence and predictors of self-reported risk behaviors among male injecting drug users

Background: Unsafe injecting drug use is a documented risk factor for the transmission of human immunodeficiency virus infection. Harm reduction strategy aims at reducing this deleterious consequence. Objectives: To study the prevalence and predictors of injecting as well as sexual risk behavior among male injecting drug users (IDUs). Methods: A cross-sectional study was conducted among 250 male IDUs from January 2017 to March 2018. Risk behavioral data were collected after obtaining informed consent of the study participants. This included information on sharing, reusing needles/injections, and sexual behavior. Descriptive statistics and logistic regression model was run using the Epi Info software version 7.2 for Windows. Results: In the past one month, 25.3% had shared needles/syringes by either borrowing or lending or both. Inconsistent condom use during sexual intercourse with a regular, casual, and paid sex partner was practiced by 64.7% (77/119), 65.8% (48/73), and 45.0% (18/40), respectively. The binary logistic regression analysis revealed that unsafe injecting drug behavior was higher among daily users: (OR = 3.0 [1.3–6.6]) and comparatively lower among those who preferred to avail needles/syringes from Needle Syringe Exchange Program (OR = 0.4 [0.2–0.9]); as compared to their counterparts. Conclusions: The findings suggest that IDUs in the study area are engaging in risk behaviors. Behavior change communication and harm reduction strategy should be strengthened.

Modern Naturalistic Enclosures: Comparatively an Enhanced Management Practice of Captive Felids in the Zoological Park

Due to the expansion of human population, threat for existence of all wild animals is gradually increasing. They are driven to exist in smaller areas and in the worst case scenario extinction. Zoos are being encouraged to improve the animal’s physical and social surroundings. In this study, the modern naturalistic enrichment introduced to large felids tiger, lion and leopard at Gandhi Zoological Park, Gwalior, Madhya Pradesh, was studied. The study has envisaged evaluating if the modern naturalistic enclosures could increase activity levels and how the felids opted to these enclosure. The enclosures were divided into menageries and natural enrichment, which had a varying degree of opportunities for the animals to climb, hide and rest above ground level. The environmental enrichment effects on the proportion of time spent engaging in active behaviors and stereotypic pacing in the large felids were compared and recorded using instantaneous scan sampling. The results of this study revealed clearly that large felids kept in more natural and complex enclosures performed less stereotypic pacing (unnatural behavior), and more exploratory (natural) behaviour than those housed in less natural enclosures reducing the stress level in captive tigers will enhance the animals’ overall physical and psychological well being, which will in turn increase the success of captive breeding programs. Furthermore, these results suggest that captive tigers should be housed in large enclosures containing natural substrate and vegetation, water pools, ample shade, a variety of resting locations and enrichment items

Multiple Calcified Scrotal Sebaceous Cysts: A Rare Case Presentation

A sebaceous cyst is a retention cyst. The classical management of scrotal sebaceous cysts is complete surgical excision and in the current era and as expected from the patient from the doctor and as the duty of the doctor, excellent outcome, minimal morbidity with good cosmetic results.

Echocardiographic Findings in Submassive Pulmonary Embolism.

Echocardiography provides important clues for diagnosis of submassive pulmonary embolism in a high-risk patient. Disproportionate right ventricular dilatation and dysfunction with apical sparing in the setting of mild-to-moderate pulmonary artery hypertension should raise suspicion. Absence of any regional wall motion abnormality of left ventricle is an important negative finding.

Syncope: Evaluation and Management.

Syncope is a common symptom in clinical practice. Causes can be relatively benign or potentially lethal. Knowledge of what actually occurs during a spontaneous syncopal episode is ideally the gold standard to determine etiology.

Evaluation of the effect of presence of blood in the stomach on endoscopic diagnostic tests for Helicobacter pylori infection.

Introduction: Presence of blood in the stomach has been thought to affect the performance of diagnostic tests used in detecting Helicobacter pylori (H. pylori) in the stomach. This study evaluated the effect of blood on the efficacy of rapid urease test (RUT) and microscopic appearance of the biopsy after staining with Giemsa stain. Materials and Methods: Patients with bleeding oesophageal varices who met the inclusion criteria were tested for H. pylori by RUT and microscopic examination of the biopsy. A repeat endoscopy, RUT and histology were done one month following initial presentation. The performance of the diagnostic tests was evaluated with and without the presence of intraluminal blood. A combined result of the two tests, RUT and histology, carried out in presence or absence of blood for the diagnosis of H. pylori, when considered together was considered as the gold standard. Results: Thirty six patients included in the study were in the ages ranging between 15-60 years (mean age = 44.14 years ±2.1). The combination of tests at both visits showed 20/36 (55.6%) patients were positive for H. pylori. The decrease in H. pylori positivity in the presence of blood was significant for RUT (8.3% vs. 38.9%; P=0.005) and combined test (19.4% vs. 47.2%; P=0.02) but the decrease in positivity for histology (11.1% vs 30.6%) was not significant (P=0.08). In the presence of blood, the sensitivity of RUT, histology and combined tests were 15%, 20% and 35%, respectively. In the absence of blood, the sensitivity of RUT, histology and combination of tests was 70%, 55% and 85%, respectively. Conclusion: Blood in the stomach significantly decreased the sensitivity of RUT, histology and the combination of both. Negative results of these tests in acute upper gastro intestinal (GI) bleeding should therefore be interpreted carefully.

Quantitative analysis of six gene products as candidate markers of early placental villi development in the human.

Early placental development is critical for successful pregnancy. Recently, we have reported that ~70 genes were differentially expressed in human placental villi between 6- and 8- weeks of gestation in cDNAbased expression arrays for ~400 PCR products, of which six specific gene products (COL4A4, CXCR4, ERBB2, HDAC1, HPRT1, and TNFRSF1A) appeared intriguing. In the present study we have examined expressions of these six candidate genes in placental villi obtained from 6-weeks, 7-weeks and 8-weeks (n = 6 for each group) human placental samples using quantitative real time RTPCR. We observed that there was considerable concordance (>95% confidence) in pair-wise analysis of transcript profiles between the two methods, however, absolute quantitative values as measured by quantitative RTPCR differed from those obtained from cDNA-based array analysis for 2 gene products (CXCR4 and ERBB2) out of 6 genes. No significant change was observed in the steady state expression of COL4A4 and HPRT1 during the time period examined. However, there was significant decrease in CXCR4 for 7-weeks (P< 0.01) and 8-weeks (P<0.05) samples, and significant (P<0.05) increase was seen for ERBB2 in 7-weeks and 8-weeks as compared to 6-weeks samples with no change between 7-weeks and 8-weeks samples. Moreover, significant (P< 0.05) increase for HDAC1 and decrease for TNFRSF1A was observed in 8-weeks samples as compared to 6-weeks samples with no change observed between 6-weeks and 7-weeks samples. We infer that it is essential that cDNA array-based data are verified in terms of quantitative estimates preferably by quantitative PCR before their use for any exploratory purpose. Taking together our previous array based data and the present study we conclude that a categorical balance exists between the expression of ERBB2 and HDAC1 genes affecting cell proliferation and differentiation in one hand, and CXCR4 and TNFRSF1A affecting chemotaxis, inflammatory response and apoptosis on the other hand. The expression of these genes appear important for the early development of human placental villi.

Small scale transcript expression profile of human first trimester placental villi analyzed by a custom-tailored cDNA array.

Human placental trophoblastic mass grows rapidly between 4 and 8 weeks of gestation making it highly vulnerable to external and internal challenges, however, there has been no reported study exploring the developmental molecular characteristics in human first trimester placental villi. In the present study, transcript expressions of human placental villi of normal pregnancies during 6 (n=6), 7 (n=6) and 8 (n=6) weeks of gestation using custom-tailored cDNA-based expression arrays for ~400 annotated human gene products were examined. Unsupervised and supervised analyses of expression data revealed that 386 (95%) genes were overtly involved in the first trimester placental villi, and these genes segregated into three clusters specifically corresponding to 6-, 7- and 8- weeks of gestation in principal component analysis. Bayesian prediction analysis based on relative expression levels of genes studied identified that expression patterns in 15 samples out of 18 samples showed concordance with high (0.8-1.0) confidence measures with the chronological age of the placenta, however, two samples collected during 7-weeks of gestation and one sample collected during 8-weeks of gestation were predicted to be 6- weeks sample with confidence measures between 0.6 and 0.5. Unsupervised hierarchical clustering analysis segregated the samples into two major branches; while one of them was composed of five 7-weeks samples only, the second major branch had three sub-branches: one of them was exclusively composed of three 8-week samples only, while other two subbranches were mainly composed of 6-weeks samples. K-means clustering analysis identified four optimal clusters of genes depending on the similarity of their relative expression for the set of genes studied across all the samples. Gene ontology (GO) based functional classifications of genes in K-means clusters revealed that the overall putative functions of co-regulated gene clusters were mutually comparable, however, specific genes related to ion homeostasis, metabolism, and VEGF activity specifically clustered in 8-weeks samples. Analysis of relative gene expression during in 6-8 weekplacental villi revealed that a large number of gene products were over represented by their either up-regulation (70 genes: ~18%) or down regulation (53 genes; ~14%) between 6 and 8 weeks villi samples and these genes are reportedly involved in biological processes like regulation of cell growth and proliferation, anti-apoptosis, angiogenesis, immune and inflammatory responses, extracellular matrix remodeling and multicellular organismal development involving almost all cellular components and molecular functions like signal transduction activity, transcription factor activity, nucleotide and protein binding, ion (especially calcium and zinc) binding and growth receptor activities. Interestingly, four genes (oxytocin receptor, tenascin C, TNF-R1 and retinol binding protein 1) showed differential regulation in human placental villi during 6-8 weeks of gestation, suggestive of an underlying network of regulation involving these factors in the developing placenta. To our knowledge, this is the first report indicating that these genes are involved in the early stage development of human placenta.

Comet assay: A prognostic tool for DNA integrity assessment in infertile men opting for assisted reproduction.

Background & objectives: The growing concern on transmission of genetic diseases in assisted reproduction technique (ART) and the lacunae in the conventional semen analysis to accurately predict the semen quality has led to the need for new techniques to identify the best quality sperm that can be used in assisted procreation techniques. This study analyzes the sperm parameters in the context of DNA damage in cytogenetically normal, AZF non deleted infertile men for DNA damage by comet assay. Methods: Seventy infertile men and 40 fertile controls were evaluated for the semen quality by conventional semen parameters and the sperms were also analyzed for DNA integrity by comet assay. The patients were classified into oligozoospermic (O), asthenozoospermic (A), teratozoospermic (T), oligoasthenoteratozoospermic (OAT) categories and infertile men with normal semen profile. The extent of DNA damage was assessed by visual scoring method of comets. Results: Idiopathic infertile men with normal semen profile (n=18) according to conventional method and patients with history of spontaneous abortions and normal semen profile (n=10) had high degree of DNA damage (29 and 47% respectively) as compared to fertile controls (7%). The O, A, T and OAT categories of patients had a variably higher DNA damage load as compared to fertile controls. Interpretation & conclusions: The normal range and threshold for DNA damage as a predictor of male fertility potential and technique which could assess the sperm DNA damage are necessary to lower the trauma of couples experiencing recurrent spontaneous abortion or failure in ART.

Hsp90 mediates activation of the heme regulated eIF-2 kinase during oxidative stress.

The heme-regulated inhibitor (HRI), a member of the eIF-2 kinase family is crucial for regulating protein synthesis during stress. In addition to heme, stress proteins Hsp90 and Hsp70 are known to regulate HRI. The present study aims to determine the physical association of these Hsps in the regulation of HRI activation during oxidative stress using human K562 cells as a model. Extracts from the stress-induced cells were used for determining HRI kinase activity by measuring eIF-2 phosphorylation, and Hsp-HRI interaction by immunoprecipitation and immunoblot analyses. The results indicate a significant increase in both Hsp70 and Hsp90 expression during AAPH (2, 2’-azobis (2-amidinopropane) dihydrochloride)-induced oxidative stress. Further, their interaction with HRI, which correlates well with its increased HRI kinase activity leads to inhibition of protein synthesis. Thus, we demonstrate that Hsps play an important role in the regulation of initiation of protein synthesis during oxidative stress.