Double chambered right ventricle with ruptured sinus of Valsalva: rare entity

Valsalva sinus aneurysm (SVAs) and double-chambered right ventricle (DCRV)is an uncommon congenitalheart defect and are usually associated with ventricular septal defect (VSD) in 50% to 60% of patient抯 population. The current case report had documented a 59 years old hypertensive asymptomatic male with a known case of SVAs presented to our hospital following device closure for 6 months. On examination, the patient was diagnosed to have DCRV induced by SVAs prior to the closure along with other factors. However, to the best of our knowledge, this is the first case report on DCRV induced by SVAs in synergy with other associated multifactors and without VSD among the Indian population.

A rare case of mucormycosis in heart transplantation

Mucormycosisis the third most common invasive fungal infection with a high mortality rate seen in immunocompromised patients. It is an increasingly well-reported invasive fungal infection that affects recipients of solid-organ transplant. The incidence of mucormycosis in patients with heart transplants ranges from 0 to 0.6%. We reporteda case of mucormycosis in a young heart transplant male recipient.

A neglected cause of anaemia: hereditary hemorrhagic telangiectasia

Hereditary hemorrhagic telangiectasia (HHT) or Osler-Weber-Rendu syndrome is an inherited disorder characterized by vascular dysplasiasleading to hemorrhages. If affects approximately 1 in10,000 Caucasian people. The most common presentation is chronic and recurrent epistaxis whereas bleeding from other sites can lead to life-threatening complications.

“Oxygen Pheriwala: ” An Innovative Model for SARS-CoV-2 Screening in Resource-Limited Settings

The second wave of SARS?CoV?2 infection came as a hypoxic emergency and situation became worse in rural India, where undiagnosed COVID-19 patients died without any diagnosis or intervention. The primary aim of this innovative model was the early diagnosis of suspected SARS?CoV?2 cases, providing empirical treatment and timely referral to appropriate COVID care facilities. Fever was measured with infrared thermometer and oxygen saturation level with pulse oximeter. A total of 8203 people were screened, of which 274 persons were febrile and 69 (25%) were hypoxic too. Sixty?four out of 69 (93%) patients turned COVID?19 positive on reverse transcription?polymerase chain reaction. At the end of 3 weeks, 48/64 (75%) patients were successfully discharged. This model can be easily implemented in resource?limited regions to identify and prioritize the patients not only in this pandemic but also in outbreak of other communicable diseases.

Neglected basicervical neck of femur fracture treated with closed reduction and internal fixation with a cephalomedullary nail alone: A case report

A fractured neck femur presenting beyond 3 weeks is referred to as a neglected fracture. The current literature is silent about neglected Basicervical fractures. The latter behave more like an intertrochanteric fracture and thus are less prone to complications such as non-union and avascular necrosis. We report a case of an adult male of 42-year-old of age presenting with a 10-month-old history fracture neck of the left femur following high energy injury. We treated the fracture with isolated closed-reduction and internal fixation with PFNA II, as the fracture was basicervical. We have achieved a union in 6 months of surgery. The patient had an excellent functional status 1-year follow-up.

MSAP Marker Based Epigenetic Regulation in Symptomatic and Asymptomatic Floral Malady of Soybean (Glycine max)

Abstract: It has learned that soybean is being affected by a floral disorder known as floral malady where plants fail to develop pod and do notattendfull maturity. For this floral disorder, we present a new methylation-sensitive amplified polymorphism (MSAP) approach for the evaluation of relative quantitative characteristics of non-methylation, hyper-methylation, hemi-methylation, and full methylation status of CCGG sequences, which are recognized by the isoschizomers HpaII and MspI. We applied a technique to analyze alterations in the cytosine methylation a popular Indian soybean (Glycine max L.) genotype, JS-335.The result revealed that in the symptomatic plant, out of 392 MSAP sites, 281 (71.68%), 33 (8.41%),38 (9.69%), and 40(10.20%) found to beun-methylated, hemi-methylated, fully methylated and hyper-methylated, respectively. Whereas, the MSAP profile of asymptomatic plants revealedout of 402MSAP sites, 330 (81.28%) was un-methylated, 22(5.41%) hemi-methylated,29(7.14%) fully methylatedand 25 (6.15%) hypermethylated. In comparison with asymptomatic(18.71%) plant, approximately 10% increased methylation was noted in symptomatic(28.31%) plantprofiles. The increased levels of methylation was recorded in the symptomatic plants about 28.31%and18.71% in asymptomatic. The study showed a higher epigenetic influence on JS-335 genotype of floral malady symptomatic than same genotype of asymptomatic plant. No pod formation in symptomatic plant induce genome wide changes either in promoter or coding region of gene(s) and DNA fragments showing polymorphism related to differences in pattern and extent of methylation associated with floral malady.

Preparation and physicochemical characterization of ghee and mūrcchita ghŗ̥ta

Background: Ghr¸ta murcchana _x005F_x005F_x0001_ is a process of pre-treatment recommended in Ayurveda to purify gheebefore it can be used for siddha ghr¸ta which is claimed to improve the properties of the ghee in generaland that of the prepared siddha ghr¸ta.Objective: This work is aimed at studying the physiochemical properties of ghee and murcchita ghr¸ _x005F_x005F_x0001_ ta inorder to understand the impact of ghr¸ta murcchana _x005F_x005F_x0001_ process.Materials and methods: Ghee and murcchita ghr¸ _x005F_x005F_x0001_ ta were prepared from the milk of local Pahadi, Jersey andHolstein cows. The samples were characterized by FTIR spectroscopy, differential scanning calorimetryand free fatty acid measurements.Results: Among the samples studied, the Holstein cow ghee was found to contain the least amount offree acid (1.34%) whereas ghr¸ta murcchana _x005F_x005F_x0001_ process led to further decrease in the free acid contentpolymorphism was observed in the samples as evidenced by multiple melting points. In most cases,murcchita ghr¸ _x005F_x005F_x0001_ ta was found to contain less solid fat than the corresponding ghee implying that the highmelting compound was converted to low melting one during the process.Conclusion: The observed lowering of free fatty acid and solid fat contents in the ghee samples mayprovide a possible validation to the performance enhancement of the ghr¸ta murcchana _x005F_x005F_x0001_ process.

Prevalence and clinical manifestations of vitamin K deficiency in complicated severe acute malnutrition

Background: In Severe Acute Malnutrition (SAM) clinical and biochemical abnormalities are commonly observed. In this institute author observed that many children of complicated SAM had bleeding manifestations but there is no defined prevalence of vitamin K deficiency in SAM that's why author have planned this study.Methods: This was the hospital based prospective study conducted in 150 complicated SAM children. All children were treated according to WHO protocol for SAM management. Prothrombin Time (PT), International Normalized Ratio (INR), activated Partial Thromboplastin Time (aPTT) along with routine investigations were done on admission. All the collected data was managed and analyzed with standard software Biostatics (SPSS Version 20).Results: Total 150 complicated SAM children were studied for prevalence and clinical manifestations of vitamin K deficiency. Mean age of children was 17.03'11.0 months, 52.0% were male and 48.0% were female children. Average weight was 5.92'1.57 kg. Average height/length was 70.66'8.38 cm and mean MUAC was 10.47'1.31 cm. Out of 150, 42(28%) children had abnormal INR and 28(18.7%) had abnormal aPTT with abnormal INR. The mean INR was 2.11'1.1 and mean aPTT was 45.30'9.59 in children those had abnormal INR. Twelve out of 42(28.6%) had various bleeding manifestations and majority (66.6%) had gastrointestinal bleeding.Conclusions: More than one fourth children (28%) of complicated SAM children are having vitamin K deficiency and majority of children present with gastrointestinal bleeding.

Xylanolytic and Ethanologenic Potential of Gut Associated Yeasts from Different Species of Termites from India

Xylophagous termites are capable of degrading lignocellulose by symbiotic gut microorganisms along with the host’s indigenous enzymes. Therefore, the termite gut might be a potential niche to obtain natural yeasts with celluloytic, xylanolytic and ethanologenic traits required for bioethanol production from lignocellulosic biomass. In this study, we cultured 79 yeasts from three different termites viz. Coptotermes heimi, Odontotermes javanicus and Odontotermes obesus. After suitable screening methods, we identified 53 yeasts, which belonged to 10 genera and 16 different species of both ascomycetous and basidiomycetous yeasts. Most yeasts in the present study represent their first-ever isolation from the termite gut. Representative strains of identified yeasts were evaluated for their cellulolytic, xylanolytic, and ethanologenic abilities. None of the isolates showed cellulase activity; 22 showed xylanolytic activity, while six produced substantial quantities of ethanol. Among xylanolytic cultures, Pseudozyma hubeiensis STAG 1.7 and Hannaella pagnoccae STAG 1.14 produced 1.31 and 1.17 IU of xylanase. Among ethanologenic yeasts, the strains belonging to genera Candida and Kodamaea produced high amount of ethanol. Overall, highest ethanol level of 4.42 g/L was produced by Candida tropicalis TS32 using 1% glucose, which increased up to 22.92 g/L at 35 °C, pH 4.5 with 5% glucose. Fermentation of rice straw hydrolysate gave 8.95 g/l of ethanol with a yield of 0.42 g/g using the strain TS32. Our study highlights the gut of wood-feeding termites as a potential source of diverse yeasts that would be useful in the production of xylanase and bioethanol.

Xylanolytic and Ethanologenic Potential of Gut Associated Yeasts from Different Species of Termites from India

Xylophagous termites are capable of degrading lignocellulose by symbiotic gut microorganisms along with the host’s indigenous enzymes. Therefore, the termite gut might be a potential niche to obtain natural yeasts with celluloytic, xylanolytic and ethanologenic traits required for bioethanol production from lignocellulosic biomass. In this study, we cultured 79 yeasts from three different termites viz. Coptotermes heimi, Odontotermes javanicus and Odontotermes obesus. After suitable screening methods, we identified 53 yeasts, which belonged to 10 genera and 16 different species of both ascomycetous and basidiomycetous yeasts. Most yeasts in the present study represent their first-ever isolation from the termite gut. Representative strains of identified yeasts were evaluated for their cellulolytic, xylanolytic, and ethanologenic abilities. None of the isolates showed cellulase activity; 22 showed xylanolytic activity, while six produced substantial quantities of ethanol. Among xylanolytic cultures, Pseudozyma hubeiensis STAG 1.7 and Hannaella pagnoccae STAG 1.14 produced 1.31 and 1.17 IU of xylanase. Among ethanologenic yeasts, the strains belonging to genera Candida and Kodamaea produced high amount of ethanol. Overall, highest ethanol level of 4.42 g/L was produced by Candida tropicalis TS32 using 1% glucose, which increased up to 22.92 g/L at 35 °C, pH 4.5 with 5% glucose. Fermentation of rice straw hydrolysate gave 8.95 g/l of ethanol with a yield of 0.42 g/g using the strain TS32. Our study highlights the gut of wood-feeding termites as a potential source of diverse yeasts that would be useful in the production of xylanase and bioethanol.

Microvascular complications and their prevalence in newly diagnosed type-2 diabetes mellitus

Background: A group of metabolic diseases is ‘diabetes’ which has become a major global concern is characterized by high blood sugar. In the world about 347 million people have diabetes. Untreated long standing hyperglycemia leads to microvascular complications in newly diagnosed DM. The objective of the study was to find out prevalence of microvascular complications in newly diagnosed Type-2 diabetes mellitus.Methods: The present cross-sectional study was conducted over a period of 6 months involved 200 patients who were diagnosed with T2DM having ≤6 months duration was conducted in the out-patient department of medicine and ophthalmology at a tertiary care hospital. Informed consent was taken from all the participants who were willing to participate. Detailed history, clinical examination and relevant investigations were done to diagnose microvascular complications.Results: Maximum number of studied subjects i.e. 54% were seen in age group of 41-50 yrs. Males were 56% whereas females comprised 44%. Total of 52% of subjects were from rural background. Nephropathy was the most common microvascular complication present in 54% patients followed by neuropathy in 30% and retinopathy in 8% (NPDR in 7% and PDR in 1%) of patients.Conclusions: From the present study it has been concluded that nephropathy is the most common microvascular complication in newly diagnosed T2DM followed by neuropathy and retinopathy. Authors recommend that education of high-risk group regarding diabetes and its complications by electronic and print media is required so that they seek medical consultation at the earliest. Screening for diabetes at a younger age in view of lower average age at presentation and high prevalence of microvascular complications.

A Prospective Randomized Control Trial to Study Effect of Priming Principle on the Induction Dose Requirements of Propofol.

Introduction: Priming refers to administration of asubanaesthetic dose (priming dose) of an agent prior to itsactual anaesthetic dose. The “priming principle” is a methodto reduce the total dose requirements of a drug. This studywas undertaken to study the effect of priming principle oninduction dose requirements of propofol.Material and Methods: Sixty (60) patients with AmericanSociety of Anaesthesiologists (ASA) I and ASA II grades,of both sexes, aged 18-55 years, and undergoing electivesurgical procedures under general anaesthesia were randomlyallocated into two equal groups with 30 patients each. GroupI (control) received calculated induction dose of injection(inj.) propofol 2mg/kg. Group II (study) received 20% of totalcalculated induction dose of propofol 2 mg/kg as a primingdose and remaining dose after 60 seconds titrated till loss ofthe eyelash reflex.Results: The control group consumed a higher dose of inj.propofol (2 mg/kg) as compared with the study group (1.34± 0.28 mg/kg), i.e., there was 33% reduction of the total dosein the study group. The hemodynamic changes in HR, SBP,DBP, MAP and RPP at 30 minutes before induction, justbefore induction, immediately after intubation and 5 minutesafter induction were similar in both groups (P > 0.05) .Thehemodynamic changes in HR, SBP, DBP, MAP and RPP atone minute after induction were statistically significant inboth the groups (P< 0.05). Incidence of pain and apnea wascomparable in both groups but hypotension was seen in 4patients in control group and none in study group.Conclusion: The priming technique effectively reduced thetotal induction dose requirements of propofol and favourablyreduced extent of hypotension following induction withpropofol.

Improvement in Successful Extubation in Newborns After a Protocol-driven Approach: A Quality Improvement Initiative

Objective: To reduce extubation failure rate by implementing protocol-driven ventilation andextubation strategies. Methods: Quality improvement project in a level II neonatal care unitfrom April 2017 to January 2018. Ventilation and extubation protocols implemented from 1August, 2017. 18 ventilated newborns in the pre-protocol period, 16 in Plan-do-check-act(PDCA) cycle I and 17 in PDCA cycle II.Primary outcome wasextubation failure within thefirst 72 h of extubation. Results: Extubation failure rate reduced from 41.7% (pre-protocolperiod) to 23.8% (PDCA 1 and 2, OR 0.44, 95% CI 0.12 to 1.59, P = 0.21). Median time to firstextubation attempt significantly decreased (71.5 h to 38 h, P=0.046). Conclusions: Aprotocolized approach through quality improvement initiative demonstrated a sustainedimprovement in successful extubation with a significant reduction in the median time to firstextubation attempt in ventilated newborns

A 5 year retrospective study on epidemiological pattern of ocular trauma

Background: One of the delicate structure in the human body is eye and trauma to the eye is essentially a very grave matter. Major cause of preventable monocular blindness and visual impairment in the world is ocular trauma. So any injury to the eye must be deemed to be an ocular emergency and should be handled with utmost care. Despite its public health importance, there is relatively less population based data on the magnitude and risk factors for ocular trauma specially from developing countries. The objective of the study was to find out the epidemiological pattern of ocular trauma.Methods: The present study was 5 year retrospective study of all the patients who reported directly with ocular injury or referred from the casualty to the department of ophthalmology from January 2013 to January 2018. Various parameters like age, sex, mode of injury, type of injury etc. of all patients seen during this period were analyzed.Results: Total of 4192 ocular trauma patients were seen during study period. Maximum number of ocular trauma patients i.e. 1146 were seen in age group of 21-30 years. Males i.e. 3490 outnumbered females in the present study. Road traffic accidents were the most common cause of ocular trauma and accounts for 1760 cases. Most common reported ocular trauma was periorbital oedema/ecchymosis followed by laceration. Surgical intervention was done in 1660 cases whereas 2532 were managed medically.Conclusions: From present study, we may conclude that the maximum number of ocular trauma patients were seen in the age group of 21-30 years with more preponderance in males. Road traffic accidents were the most common cause of ocular trauma. The fact that the lifetime prevalence of ocular trauma is higher than that of eye diseases, which can be decreased by implementing the traffic rules with strict force and imposing heavy fine and license cancellation for drunken driving.

Comparative Evaluation of Nemoceph and Foxit PDF Reader for Steiner’s Cephalometric Analysis

Cephalometry is used to quantify and qualify the type of malocclusion. The digital technology has overcome the limitations of manual method. A high cost of the commercially available software is unaffordable for its wide spread use. Objectives: The aim of this study was to evaluate and compare the values of Steiner’s cephalometric analysis using Nemoceph and Foxit PDF reader. No significant difference between the two methods will result in that Foxit PDF reader can be used as an cost effective alternative. Methods: This study was conducted on 100 digital lateral cephalogram taken from the same machine. The samples were collected by non-probability convenience sampling procedures. These images were analyzed for Steiner’s Cephalometric Analysis using the two software. Results: The skeletal and dental values showed no statistical significant difference in the majority, except for the L1-NA (Linear) and L1-NB (Linear). Conclusion: Results showed that there is a high agreement between the two methods.

Comparative Evaluation of CEPH Ninja for Android and Nemoceph for Computer for Steiner’s Cephalometric Analysis

Orthodontics and Dentofacial Orthopaedics, requires a cautious acquisition and interpretation of a large amount of information to achieve a correct diagnosis and treatment planning. Manual techniques are time consuming and tedious. The digital technology is advantageous but the affordability remains obstacle. Objectives: The main aim of this study was to compare the linear and angular measures between the two methods, Ceph Ninja and Nemoceph. No significant difference between the two methods will result in that Ceph Ninja can be used as an alternative. Methods: This study was conducted on 100 digital lateral cephalogram taken from the same machine. The samples were collected by non-probability convenience sampling procedures. These images were analyzed for Steiner’s Cephalometric Analysis using the two software. Results: The results of this study showed the skeletal and dental values had no statistical significant difference in the majority, except for the linear values of Lower Incisor and Upper Incisor with N-A and N-B respectively. Conclusion: It seems that the two software can be used interchangeably with high confidence.

Perforating Ocular Injuries- A Retrospective Study From Tertiary Care Hospital Of North India.

Background: Ocular trauma is one of the main cause of corneal blindness which affects 12% of world’s population & is amenable to treatment. The leading cause of non-congenital unilateral blindness in children is ocular trauma. Children suffer a higher percentage of open globe injuries than adults which yield worse visual outcomes in ocular trauma. Aims: The objective of the study was to analyse epidemiological pattern of perforating ocular injuries. Materials & Methods: The present 5 years retrospective study involves all the patients who had been reported as a case of perforating/penetrating ocular injury in the tertiary care hospital. The records of all patients with perforating ocular injury seen during this period were reviewed & data such as demographic details, presenting visual acuity, all ocular findings, examinations etc were collected. Results: Total of 365 perforating/penetrating ocular injury patients were seen during study period. Maximum incidence of perforating injuries was noticed ≤10 years of age i.e. 36.2%. Males (79.5%) outnumbered females in the present study. Regarding structural involvement, cornea constitute (65.5%) perforating injuries followed by corneoscleral i.e. 19.7%. Conclusion: From present study, we may conclude that maximum incidence of perforating injury was noticed in children with more preponderance in males. Corneal perforation is more common as it is the most exposed part of eye.

A Prospective Study on Incidence of Peripheral Vascular Disease in Type 2 Diabetes Mellitus

Background: Diabetes levies a heavy toll on the vascular system, with both macrovascular and microvascular complications. PAD is one of the major microvascular complications of Type 2 DM [2]. PAD is highly prevalent in diabetes. It has a predilection for lower limbs. It has been assumed that the metabolic abnormality in the prediabetic phase predisposes to more distal and aggressive atherosclerosis. Methods: The duration of study was over a period of 6 month. Total 75 cases were included in this study with diabetic mellitus. This study was conducted in the Department of surgery in Krishna Mohan Medical College & Hospital, Mathura, U.P, India. Result: In our study 75 cases with diabetic mellitus were included. Out of 75 cases 64% male & 36% were female. Predominant age was >75 year followed by other age groups. In this present study, 15 cases of hypertensive & 2 cases of PVD out of hypertensive were found. Conclusion: This study suggested that incidence of PVD is about 10% in the present study. This has to be viewed seriously considering the huge diabetic population and due importance to be given for screening and prevention of PVD.

Visual Outcome among Patients Undergone Manual Small Incision Cataract Surgery Following their Identification in Screening Eye Camp in Jammu Province.

Introduction: One of the documented leading cause ofblindness in India is cataract as many patients with cataract donot have access to hospitals and surgery and to avoid blindnessdue to cataract, the only remedy is to perform hospital basedcataract surgery on a large scale. There is an increase in anumber of cataract patients due to improved quality of life,health indices and increased life expectancy. Study aimedto see the visual outcome and complications among patientsundergone manual SICS with PC-IOL implantation.Material and Methods: The present prospectiveobservational study was conducted on 72 patients who wereselected in various screening eye camps to undergo cataractextraction surgery by manual small incision cataract surgerytechnique with posterior chamber IOL implantation (MSICSwith PC-IOL).Results: Total of 72 eyes of patients who underwent manualsmall incision cataract surgery were studied. Best correctedpreoperative visual acuity of ≥ 6/60 was found in 13 patientswhile postoperatively on day1 total of 60 patients had visualacuity of ≥ 6/60. The final 6th week postoperative bestcorrected visual acuity of 6/12-6/9 was found in 65 patients.Iris prolapse was seen in 3 patients followed by posteriorcapsule rent which was seen in 2 patients. Mild postoperativeuveitis was seen in 20 followed by striate keratopathy in 8patients while hyphaema was seen in 2 patients.Conclusion: MSICS is a safe and effective procedure, due toits low rates of intraoperative and postoperative complicationswhich are easily treatable. Visual acuity is only one measureof the functional success of cataract surgery and the goodpostoperative visual outcomes achieved by our patientsfurther adds on to its benefits as a good surgical technique.MSICS can be performed as procedure of choice for largevolume cataract surgeries