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Leptospirosis is a disease that can be transmitted from animals to humans. It is caused by a bacterium called Leptospira interrogans and is more common in tropical and subtropical regions. Despite being the most neglected tropical disease, it is a significant emerging and re-emerging disease, according to recent reports and reviews by the World Health Organization (WHO). Leptospirosis is widespread among humans and animals globally, and it is estimated that there are 1.03 million cases and 58,900 deaths annually, with a case fatality rate of 6.85%. Acute transverse myelitis (TM) is a rare neurological disease that affects the spinal cord. It is caused by various autoimmune reactions and is usually limited to several spinal cord segments. It has a poor prognosis. Our case report presents a unique situation where a patient developed multiorgan failure due to leptospirosis and also had a rare co-presentation of transverse myelitis.
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Background: Folic acid supplementation during the periconceptional period is critical in preventing neural tube defects (NTDs) in the developing fetus. In Pakistan, a profound lack of awareness is seen regarding preventable pregnancy-related illnesses and the consequential high maternal and fetal mortality and morbidity rates. However, data from the surveys in the region of Sindh lacks inquiries regarding the baseline characteristics of the surveyed participants. Therefore, this study endeavoured to address this gap. Methods: Between October 2022 and April 2023, a cross-sectional study was conducted at two major tertiary care hospitals in Hyderabad and Jamshoro, Pakistan. A total of 374 participants, chosen by non-probability consecutive sampling, comprised the sample size. The association of demographic variables and knowledge, attitude, and practice of consumption of folic acid during pregnancy was determined using the ?2 test. A p value of less than 0.5 was considered statistically significant. Results: The mean age of the participants was 26.4�7 years. A total of 199 (53.20%) participants were literate, compared to 175 (46.79%) participants who were illiterate. Literate women fared better than illiterate women in all the metrics with a p-value of <0.001 and a Pearson correlation coefficient (r) of >0.7. Moreover, folic acid was consumed by only 38% of pregnant women during the periconceptional period. Conclusions: A substantial lack of knowledge regarding folic acid was found in the surveyed sample, significantly more marked in the illiterate faction. Additionally, the practice was rather unsatisfactory. However, the attitude remained encouraging.
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There are many different clinical manifestations of celiac disease (CD), including the classical form, in which intestinal symptomatology predominates on the contrary there is atypical forms, in which extra-intestinal clinical features predominate, and the silent form, in which there are no clinical symptoms. Few or no gastrointestinal symptoms and a predominance of extra-intestinal features, including liver, kidney, skeletal, psychiatric, neurologic, dermatologic, hematologic, endocrinological, and reproductive involvements, define the atypical forms of the disease. Through screening high-risk groups, silent presentations of CD may be found. It is crucial for healthcare professionals to have a high level of suspicion for the atypical presentations of CD because it is now well known that CD may account for a number of chronic health issues.
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Cancer is a significant healthcare problem. However, advancements in diagnostic procedures and therapeutic modalities have led to a decline in cancer mortality rates by 1% annually in most countries. Cancer patients often experience symptoms such as pain, cancer-related fatigue, anxiety, and lymphedema. To counter these side effects, there have been tremendous efforts. One such effort is the use of virtual reality (VR) technology, which is an interactive technology. VR has played a significant role in managing disorders such as phobias and anxiety disorders, and support for patients with cognitive and physical rehabilitation, acute and chronic pain management, and emotional support in different settings such as during hospitalizations. Our team conducted an extensive search for electronic literature on virtual reality in various databases, such as Medline, PubMed, Google Scholar, and Psych INFO, up to July 2023. We used keywords like "virtual reality," "cancer care," "depression," "cognition," "pain," "telemedicine," "rehabilitation care," "physical therapy," "radiotherapy," "telerehabilitation," "avatar," "video games," and "visual aid" as our search criteria. VR interventions for cancer patients include exposure therapy, psycho-education, and relaxation techniques, which have been shown to reduce symptoms significantly. VR distraction can also mitigate pain during medical procedures. Studies suggest that VR holds promise in rehabilitation and oncologic treatment, as it can improve function metrics, range of motion, and motivation for treatment. The review scrutinizes the use of digital information and virtual reality technology to alleviate cancer-related distress by providing remote care.
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Systemic lupus erythematosus (SLE) is a chronic autoimmune disease which presents most commonly in middle aged females and affects multiple organ systems. Amongst the many systems involved, the nervous system generally gets affected later in the course of the disease. We report a case of a male patient who developed quadriparesis as the initial presentation of SLE who progressed to lupus nephritis. The patient was started on methylprednisolone, and later planned on IVIg when he did not respond to the initial treatment. Unfortunately, the patient developed diaphragmatic paralysis and succumbed to the illness.
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A male in his late teens presented with sudden onset left-sided hemiparesis and right-sided facial weakness. The patient had a history of persistent pulsatile headache for 1 year with the blurring of vision. He also had a history of diaphoresis and palpitations. The patient was diagnosed as a case of hypertension 1 year back. On examination, Right-sided upper motor neuron type facial palsy was present, and power was 0/5 in the left upper and lower limbs; BP was 220/120 mm Hg and was controlled using prazosin and nifedipine. A non-contrast computed-tomography scan (NCCT) of the brain revealed an intracerebral hemorrhage in the right ganglio-capsular region. Abdominal CT scan findings revealed a right suprarenal mass. 24-hour urinary normetanephrine was elevated, suggesting a diagnosis of pheochromocytoma. The surgical resection of the mass was delayed as the patient had developed Dengue shock syndrome, and he died of multiple organ dysfunction syndrome.
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Objective: To optimize the ultrasonication method for efficient extraction of β-sitosterol and lupeol from the roots of Astragalus atropilosus using Box-Behnken design of response surface methodology (RSM), and its validation by high performance thin layer chromatography (HPTLC) method.Methods: Ultrasonication method was used to extract β-sitosterol and lupeol from Astragalus atropilosus (roots). RSM was used to optimize the different extraction parameters viz. liquid to solid ratio (10–14 mL/g), temperature (60-80 ℃) and time (40–60 min) to maximize the yield of β-sitosterol and lupeol. The quantitative estimation of β-sitosterol and lupeol was done in chloroform extract of Astragalus atropilosus by validated HPTLC method on 10 cm × 20 cm glass-backed silica gel 60F254 plate using hexane and ethyl acetate (8:2, v/v) as mobile phase. Results: A quadratic polynomial model was found to be most appropriate with regard to R1 (yield of total extraction; R2/％ CV = 0.9948/0.28), R2 (β-sitosterol yield; R2/％ CV = 0.9923/0.39) and R3 (lupeol yield; R2/％ CV = 0.9942/0.97). The values of adjusted R2/predicted R2/signal to noise ratio for R1, R2, and R3 were 0.9782/0.9551/48.77, 0.9904/0.9110/31.33, and 0.9927/0.9401/36.08, respectively, indicating a high degree of correlation and adequate signal. The linear correlation plot between the predicted and experimental values for R1, R2, and R3 showed high values of R2 ranging from 0.9905-0.9973. β-sitosterol and lupeol in chloroform extract of Astragalus atropilosus were detected at Rf values of 0.22 and 0.34, respectively, at λ max = 518 nm. The optimized ultrasonic extraction produced 8.462％ w/w of R1, 0.451％ w/w of R2 and 0.172％ w/w of R3 at 13.5 mL/g liquid to solid ratio,78 ℃ of temperature and 60 min of time.Conclusions: The experimental findings of RSM optimized extraction and HPTLC analysis can be further applied for the efficient extraction of β-sitosterol and lupeol in other species of Astragalus.
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The objective of proposed work was to develop Ondansetron Hydrochloride (OND HCl) sustained release matrix tablets for the better treatment of vomiting for extended period of time. Sustained release matrix tablet is the drug delivery system that is designed to achieve a prolonged therapeutic effect by continuously releasing medication over an extended period of time after administration of single dose. The matrix tablets of OND HCl were prepared by direct compression method using varying ratio of hydroxy propyl methyl cellulose (HPMC) and ethyl cellulose. The bends of tablets were evaluated for bulk and tapped density, % compressibility index and angle of repose and powder of all formulations blend exhibited that low interparticle friction and excellent flow characteristics. The prepared matrix tablets were then assessed for different physical tests like consistency of weight, thickness, hardness, friability, drug content and in vitro drug release. Each batch of the OND HCl matrix tablets were of good quality as to hardness, thickness, friability and % medicament content. The in vitro drug release study was done for 2 hours by utilizing paddle technique in 0.1N HCl (pH 1.2) as dissolution media and 6 hours using phosphate buffer (pH 6.8) as dissolution media. The drug release study showed that all formulation FMT-1, FMT-2, FMT-3, FMT-4, FMT-5 and FMT-6 were provide the drug release on sustained manner up to 8 hrs. Amongst the developed matrix tablets formulations, FMT-2 containing ethyl cellulose (100 mg) was optimized as best because FMT-2 show highest drug release profile and promoting the sustained release of drug, which could potentially improve the patient compliance.
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Background:Prevalence of D.M. has been steadily increasing in urban as well as rural areas in India & it will be one of the major cause of death in India in 21st century. Pattern of dyslipidemia is found to be different in Type I & Type II diabetes mellitus (DM). Aims and objectives: 1) Estimation of lipid profile in Type I and Type II DM. 2) Comparison of Lipid Profile in Type I and Type II DM. Material and methods: 50 patients of each already diagnosed Type I and Type II DM patients visiting OPD. 50 age and sex matched healthy controls. FPG (Fasting Plasma Glucose) and lipid profile were studied in the groups. Statistics: Students‘t’ test was used. Results: FPG and TC, TG, LDL-C, VLDL-C were significantly high in both Type I and Type II DM compared to the controls. While HDL-C was significantly lower in diabetics compared to the controls. Among the diabetics all the parameters were significantly high in Type IIDM compared to Type I DM exceot HDL-C in which no significant difference was found. Conclusion: Glycaemic control is poorer in Type II DM compared to Type I DM. Also, dyslipidaemia is more prominent in Type II DM than in Type I DM.
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Ankyloglossia or tongue tie is a congenital oral anomaly characterised by a short lingual frenum limiting the movement of the tongue which may lead to impaired phonetics and other complications. The procedure that involves the removal of this extended band of tissue freeing the tongue is known as lingual frenectomy .Traditionally this procedure was carried out surgically but advances in dentistry today have made frenectomy by lasers possible. This case reports highlights the advantages of laser frenectomy over the surgical procedure using an 810 Diode laser.
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Hypodontia or tooth agenesis is the most common prevalent craniofacial malformation in humans. It may occur as a part of a recognized genetic syndrome or as a nonsyndromic isolated trait. Both environmental and genetic factors are involved in the etiology of hypodontia, with the latter playing a more significant role. It may be noted that bilateral agenesis of mandibular central incisors is very rare and very few cases have been reported in literature.A 12 year old child reported with congenitally missing permanent mandibular central incisors of idiopathic etiology in which the missing teeth were replaced by acrylic teeth as pontic using fiber reinforced composite. The Patient had no hereditary predisposition or any associated syndrome. The aim of enhancing esthetics and attaining functional space maintenance was thus obtained in a single sitting chair side procedure.
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Background: Families dealing with mentally retarded children undergo stress. Sociodemographic factors play a role in stress and coping mechanisms. This paper highlighting on stress and its relation with demographic variables of families with mentally retarded children is a part of a broader study on stress and coping in families with mentally retarded children. Objectives: 1. Study the sociodemographic profile of families with mentally retarded children. 2. Study the association of stress with sociodemographic variables. Material and methods: A cross sectional study was done on hundred families of mentally retarded children enrolled in special schools at Indore. Sampling procedure was convenience sampling. The study tool was a validated, pretested instrument called as the Family interview for stress and coping in mental retardation, (FISC-MR). Results: Families were found to be suffering from stress. The stress ranged from mild to severe, however it was not significantly associated with the sociodemographic variables except with maternal education level. Conclusion: Families of mentally retarded children undergo stress. Socio-demographic factors play a role in the development of stress in families with mentally retarded children.
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Coronary artery disease (CAD) is a worldwide health epidemic. Acute coronary syndrome is a potentially life-threatening condition and patient may die or become disabled in the prime of life. There is documented evidence that South Asian people develop CAD at a higher rate and also at an early age. If the affected individual is 40 yrs old or below, the tragic consequences are catastrophic. Methods: It was a retrospective observational study to find out the pattern of acute coronary syndrome in the young (40 years old or less) in a military hospital (CMH Dhaka) from July 2007 to July 2008 and to analyze the risk factors and the angiographic characteristics of coronary vessels. Consecutive 64 young patients including both male and female admitted into this hospital were the study subjects. Out of these patients 53 were males and 11 were females. Among these patients coronary risk factors and angiographic pattern were studied. 64 older patients with Acute coronary syndrome (age more than 40 years) were also studied. Results: Out of 64 young patients 15.6% patients presented to this hospital as UA, 9.37% presented as Non-Q MI, 28.12% Acute Anterior MI, 14.06% Acute Anteroseptal MI, 26.56% Acute Inferior MI, 6.25% Acute Infero-posterior MI. Smoking was the most common risk factor among these young patients. 64.06 % patients were smoker. Dyslipidaemia was present among 50 % patients, 37.55 % were hypertensive, 15.62% were diabetic, and 15.62 % were obese. SVCAD was the most common lesion and it was 53.12 %. 26.56% patients had DVCAD and TVCAD was present among 20.31 % patients. In the older group (more than 40 years) most common risk factor was dyslipidaemia (71.88%) and smoking was present among 48.43% patients. Conclusion: Young patients have a different risk factor profile in comparison with older patients. Smoking is a strong and quite common coronary risk factor in the young ACS patients who are 40 years or less. Risk factor identification and control is very crucial in the primary and secondary prevention in young patients with CAD.
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Background Information on anatomy of intrahepatic inferior vena cava (IVC) and hepatic vein openings in it is limited. Methods We studied the retrohepatic segment of IVC and hepatic vein openings in it in 69 livers obtained from cadavers. The retrohepatic portion of the IVC was opened posteriorly by a vertical cut, the exposed surface was divided into 12 quadrants and the position, size, and septation of ostia of hepatic veins and any accessory openings were charted; measurements were made using Vernier calipers. Results The median length of the intrahepatic IVC was 5.7 (range 3.3–8.2) cm and its median diameter was 2.3 (range 1.5–3.0) cm. The superior (major) set of hepatic veins comprised of two veins (right and left-middle) in 45 (65%) cases, three veins (right, middle, and left) in 23 (33%) and four veins in one (2%) case. Median diameter of the right hepatic vein was 1.5 (range 0.8–2.7) cm and that of left hepatic vein was 1.2 (0.7–2.6) cm. Middle hepatic vein, when separate, had a median diameter of 1.1 (range 0.5–1.5) cm. The inferior (minor) set of hepatic veins had two to 16 (median 7) veins. Conclusions Our data provide information on number, size, position, and septation of hepatic vein openings into the IVC. This information may be useful to hepatologists, hepatic surgeons while planning segmental resection of the liver, and to radiologists planning diagnostic and interventional procedures on hepatic venous system.
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Toxicity of copper on some metabolic processes can lead to disturbance and imbalance of various physiological activities such as respiration, reproduction, bone formation, and metabolism of some nutrients. Copper sulphate is frequently used as a general biocide in the aquaculture industry. The present study reflects the effect of copper sulphate on lipids in some vital organs of the freshwater crab Barytelphusa gureini. Crabs of equal size were treated with different concentrations of copper sulphate (0.5, 1.0, 1.5, 2.0, and 2.5 ppm) respectively. The mortality rate was noted up to 96 hours. After deducing the LC50, the crabs were treated with a sub-lethal concentration of copper sulphate (1.5 ppm) for 24, 48, 72 and 96 hours respectively. Total lipid estimation was done in the case of sub-lethal concentration (1.5 ppm) of copper sulphate exposure and compared with the control group of crabs. The results showed a significant decline in the total lipid in the following organs of Barytelphusa gureini at sublethal concentration of copper sulphate – hepatopancreas (67.7%) < muscle (58.8%) < gills (47.3%) < haemolymph (powder form) (28.8%). In contrast, there was an increase in the lipid in various organs of control crabs – hepatopancreas (0.091 mg/100 mg) > gills (0.076 mg/100 mg) > haemolymph (powder form) (0.052 mg/100 mg) > muscle (0.034 mg/100 mg). The lipid reduction in the present study is a reflection of breakdown of lipid in stress situation.
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Of all the hepatitis viruses, only the hepatitis B virus (HBV) and hepatitis C virus (HCV) cause chronic hepatitis, which can progress to cirrhosis and hepatocellular carcinoma. In this review, we discuss how these two biologically diverse viruses use common pathways to induce oxidative stress and activation of key transcription factors, known to be involved in inflammatory processes in cells. Activation of NF-kB and STAT-3 most likely contribute to the progression of viral infections to chronic hepatitis and liver oncogenesis associated with HBV and HCV infections. In this review, we focus on the mechanisms of action of HBx and HCV NS5A proteins in inducing intracellular events associated with the viral infections.