An observational study to determine the status of serum and RBC folate in drug resistant epileptic children at a tertiary care centre in Western Rajasthan, India

Background: Drug resistant epilepsies constitute about 10-20% of childhood epilepsies and treated with higher doses and multiple AEDs. AEDs increases folate metabolism by enzyme induction thus causes deficiency of folic acid.Objective was to evaluate the effect on serum and RBC folate in children having drug resistant epilepsy.Methods: In a prospective observational study 83 drug resistant epileptic children of age 6months to 180 months fulfilled the inclusion criteria enrolled in study, from Oct 2014 to Nov 2016 for a period of two years. Serum and RBC folate levels were done in these children. Epileptic children already receiving folic acid supplementation/treatment were excluded from the study. Children with serum folate level <5ng/ml and RBC folate <280ng/ml was considered as folate deficiency.Results: Total 83 children had drug resistant epilepsy (defined by ILAE). Mean age of children with drug resistant epilepsy was 71.39±49.76 months. 71.08 % were male and 28.91% were female. Mean serum folate in these children was 7.75±2.77 ng/ml and RBC folate 381.63±164.54 ng/ml which was significantly lower as compared to healthy children or epileptic not receiving AEDs. 14.45 % children in drug resistant epilepsy had serum folate <5ng/ml while 20.89% were found to be RBC folate deficient (RBC level <280ng/ml).Conclusions: Antiepileptic drugs are associated with lower blood folate status which deteriorates further with increasing number and doses of AEDs in drug resistant patients. Therefore blood folate monitoring should be done in all children on AEDs on regular intervals and should be considered in the etiologic differentials of drug resistant epilepsy.

Incidence of catheter-related bloodstream infections after removal of peripherally inserted central catheters in preterm neonates

Background: Peripherally inserted central catheter (PICC) have become essential for a safe and reliable long term venous access in all neonatal intensive care units (NICU) for providing long term intravenous fluids and medications. However, they associated with central line blood stream infections (CRBSI) infections and it is postulated that this risk is more on during their removal but the true incidence is not known. The objective was to evaluate the incidence and identify risk factors associated with CRBSI following the PICC removal in preterm neonates.Methods: This was a retrospective cohort study was done on <37 weeks premature neonates. Data included patient particulars, location of PICC placement, days of PICC, antibiotics and TPN through PICC, infections noted during or within 48 hours of PICC removal.Results: A total of 238 PICC removals in 215 neonates were analysed which did not show a significant difference in the prevalence of CRBSI within 48 hours of PICC removal. However, there was an increase in odds for sepsis following PICC removal in less than 29 weeks gestation and if it was not used for antibiotic infusion for more than 48 hours preceding its removal.Conclusions: This study does not support the use of prophylactic antibiotics during PICC removal in neonates as there was no increase in the incidence of CRBSI following PICC removal. However, they may have a role in very low gestation age, low birth weight infants who have not recently received antibiotics prior to PICC removal.

PEGylated Lipova E120 liposomes loaded with celecoxib: in-vitro characterization and enhanced in-vivo anti-inflammatory effects in rat models

Brown adipose tissue (BAT) is responsible for adaptive thermogenesis. We previously showed that genetic deficiency ofreceptor for advanced glycation end products (RAGE) prevented the effects of high-fat diet (HFD). This study was tocompare BAT activity in RAGE knock out (Ager-/-, RKO) and wild-type (WT) mice after treated with HFD or LFD.[18F]FDG PET-CT imaging under identical cold-stimulated conditions and mean standard uptake values (SUVmean), ratio ofSUViBAT/SUVmuscle (SUVR, muscle as the reference region) and %ID/g were used for BAT quantification. The resultsshowed that [18F]FDG uptake (e.g., SUVR) in WT-HFD mice was significantly reduced (three-fold) as compared to that inWT-LFD (1.40 ± 0.07 and 4.03 ± 0.38; P = 0.004). In contrast, BAT activity in RKO mice was not significantly affectedby HFD, with SUVRRKO-LFD: 2.14 ± 0.10 and SUVRRKO-LFD: 1.52 ± 0.13 (P = 0.3). The uptake in WT-LFD was almostdouble of that in RKO-LFD (P = 0.004); however, there was no significant difference between RKO-HFD and WT-HFDmice (P = 0.3). These results, corroborating our previous findings on the measurement of mRNA transcripts for UCP1 inthe BAT, suggest that RAGE may contribute to altered energy expenditure and provide a protective effect against HFD byAger deletion (Ager -/-).

Prevalence, Risk Factors and Impact of Subclinical Endometritis on Reproductive Performance of Nili-Ravi Buffalo

Subclinical endometritis (SCE) is the inflammation of endometrium without systemic illness, hence remains mostly undiagnosed and untreated. The early diagnosis necessitates the evaluation of important risk factors. The objective of this study was to identify the risk factors of SCE and their effects on reproductive performance of Nili-Ravi buffalo. 100 buffaloes approaching parturition were selected. During calving, various risk factors viz., type of calving, peri-parturient disorders, sex and birth weight of calf, gestation period and season of calving were recorded. Buffaloes were subjected to endometrial cytology using cytobrush method on 45 day postpartum (DPP) and divided into 2 groups viz., buffaloes ‘with SCE’ (>5% PMN; n=38) and ‘without SCE’ (≤5% PMN; n=62). Buffaloes in estrus were artificially inseminated and fertility parameters were recorded. The occurrence of SCE was significantly affected by calving assistance (OR=11.74; P<0.001), peri-parturient disorders (OR=6.87; P<0.05) and gestation period (OR=1.16; P<0.05). Sex, birth weight of calf and season of calving were not associated with SCE. The service period of buffaloes did not vary between two groups. The median days open was significantly (P<0.05) higher in buffaloes with as compared to buffaloes without SCE (141 vs. 117 d). Buffaloes with SCE had significantly (P<0.05) lower first service conception (21.1 vs. 43.5%) and took more (P<0.05) mean number of services per conception (2.71 vs. 1.62) compared to buffaloes without the SCE. It may be concluded that risk factors around the time of calving control the onset of SCE which in turn has negative impact on reproductive performance of Nili-Ravi buffaloes

Study of hematological parameters in sepsis patients and its prognostic implications

Background: Septic response is a leading contributory factor for morbidity and mortality especially in intensive care settings. The current research aims to study the co-relation of various hematological parameters in sepsis patients with the objective to see their effects in prognosis of sepsis patients.Methods: The current study was a cross-sectional study with a sample size of 117 patients with sepsis. Various hematological parameters of all the patients were obtained on day of admission (day 1) and seventh day (day 7) using hemogram reports and the difference of their statistical mean and standard deviation was estimated.Results: There was a significant statistical difference in the mean and standard deviation of neutrophil lymphocyte count ratio (NLCR), red cell distribution width standard deviation (RDW SD), Platelet count (PLT) and Platelet crit (PCT) whereas Mean platelet volume (MPV), Platelet distribution width (PDW) and Platelet large cell ratio (PLCR) showed no significant changes on day 1 and day 7 of observation in patients taken for the study.Conclusions: The prognosis of sepsis can be important when we can clinch the hemogram markers early in the period of sepsis and evaluate them according to the etiology of the respective incidences. Targeted approach can be initiated early in the course of hospitalization and may be a specific index of hemogram could be established to further co relate sepsis and its form in particular diseases.

Intermittent clobazam prophylaxis in simple febrile convulsions: a randomised controlled trial

Background: Febrile seizure (FS) is the most common type of childhood seizure disorder with a prevalence of 2-5% in children less than 5 years. Although the prognosis of febrile seizure is usually good, however, the possibility of recurrence keeps many parents and families in a state of anxiety and concerned, for years after the first seizure. Thus, intermittent prophylactic treatment might be advised in children with high risk of recurrence.Methods: The study was a prospective randomized, double blind, placebo-controlled trial conducted at Department of Pediatrics, Umaid Hospital, Dr S N Medical College, Jodhpur on neurologically normal children aged from 6 months to 5 years with a history of simple febrile seizures and normal electroencephalogram without any evidence of acute central nervous system infection. Subjects were randomly prescribed oral clobazam according to weight of child and placebo when they developed a febrile disease during the first 48 h of the onset of fever.' Temperature reduction measures with paracetamol and tepid sponging were also advised. Patients were followed up for the frequency and time of febrile seizure recurrence, febrile episodes and side effects of drugs for 12 months.Results: Ten (3.8%) of 257 episodes in clobazam group and 38 (14.07%) episodes in placebo group had seizure recurrence (p value <0.001). The two groups were not significantly different in terms of side effects. (p >0.05).Conclusions: Intermittent oral clobazam therapy is a very effective measure in preventing recurrence of febrile seizures.

Finding out incidence of deafness among neonates at a tertiary care centre of western Rajasthan, India using otoacoustic emission

Background: Newborn hearing screening is conducted to identify suspected hearing loss and not to confirm the presence/absence of hearing loss or define features of the loss. Speech and hearing are interrelated, i.e., a problem with one could mean a problem with the other as speech and language is acquired normally through auditory system.Methods: A descriptive study conducted in the Department of Paediatrics, Dr. S. N. Medical College, Jodhpur, from June 2016 to December 2017. 5000 neonates were screened using otoacoustic emissions (OAE) in 2 stages at birth during 3rd to 7th day and 15-30 days respectively, followed by BERA at 3 months of age.Results: 1.4 infants per thousand infants had hearing loss. Presence of high-risk factors was seen to be associated be associated with hearing loss more than normal infants on screening with distortion product otoacoustic emissions (DPOAE) tests. However, on testing with BERA no such association was seen.Conclusions: 1.4 per 1000 infants had hearing loss. This study has shown that two stage distortion product otoacoustic emissions (DPOAE) hearing screening followed by british educational research association '(BERA) to confirm the hearing deficit, can be successfully implemented as new born hearing screening method in a hospital set-up, for early detection of hearing impaired, on a large scale, to achieve the high-quality standard of screening programs in a resource limited and developing nation like India.

Changing trends in maxillofacial trauma: A 15 years retrospective study in the Southern Part of Haryana, India

The aim is to analyze the pattern of maxillofacial injuries and treatment outcomes in the past 15 years (2002–2016). Materials and Methods: One thousand eight hundred and fifty patients from two tertiary referral center hospitals were studied retrospectively in which the age, sex, etiology, site of fracture, and treatment modality was recorded. Results: One thousand two hundred and twenty-eight males and 622 females were operated between 2002 and 2016. Mean age was 29 ± 17.2 years. Maximum incidence was seen in the age group of 16–30 years in males, whereas in females, the predominance of trauma was seen in both 16–30 and 31–45 age groups. Road traffic accidents were responsible for the majority of fractures (42.2%), followed by assaults (26.4), sports injuries (17.6%), and fall (10.7%). Maximum fractures were of the mandible (53.5%) followed by midface (25.6%) and panfacial trauma (20.8%). Nearly 53.6% of patients underwent open reduction, and internal fixation (ORIF), 34.2% managed by the closed method and 12.1% were kept under observation. Conclusion: This study verified a young male predominance, a shift toward more assault related fractures, especially in females. Mandibular fractures were the most common of all. Moreover, the changing trend toward ORIF in the past 15 years.

Cheiloscopy: An Aid to Personal Identification in India.

Background: As said “Identification is an individual’s birth right”. Identification of the individual is based on certain characteristics, which is unique to that individual. Cheiloscopy is the examination of lip prints, the lip prints are permanent and fixed, like fingerprint and palatal rugae, hence it can be used in personal identification. Aim: This study is undertaken to evaluate the uniqueness of lip print for personal identification Methods: The study was carried out on 400 subjects (200 male and 200 female) among the population of India. Lipstick was applied on the lips and print was taken on bond paper, the prints were divided into four quadrants and were analyzed by using magnifying lens and Suzuki and Tsuchihashi classification were used to identify the most common type of pattern among Indians for personal identification. Results: Our study shows that the most common type of pattern in Indian race was TYPE III (39%) and in all the quadrants (I, II, III, IV) most dominant pattern was type III in males and type II in females. Conclusion: The present study reveals that, there was no similarity in the lip print pattern of one individual with that of the other individual. The lip print pattern varies between the same age group people as well as among the population of same region.

Exploring the multidimensional nature of anthropometric indicators for under-five children in India.

This study examined the multidimensional nature of the association of stunting, wasting, and underweight for children below 5 years of age in India using data from the National Family Health Survey (NFHS)-3 (2005-2006). Multiple correspondence analysis (MCA) was applied to examine the association of the indicators. Additionally, log-linear model was used to find out the model of best fit to examine the nutritional status of children. It was found that underweight is associated with both stunting and wasting, whereas there was no consistent pattern of association between stunting and wasting. The results also confirmed that children suffered from multiple anthropometric failures. The results showed that height-for-age, weight-for-height, and weight-for-age taken together give the model of best fit for analysis of nutritional status. The study concluded that the three indicators of nutritional status should be considered simultaneously to determine the percentage of undernourished children.

Not All Primary Osteolytic Mandibular Swelling Is Malignant.

Tubercular infection of the oral tissues can be primary or secondary. Primary lesions develop when tuberculosis bacilli are directly inoculated into the oral tissues of a person who has not acquired immunity to the disease. Here we present a case of 66yrs old non-smoker male presenting with a swelling in the left mandibular region (Lumpy jaw) over a period of last 1yr now presenting with weight loss, pain and trismus for 6month. No past history of tuberculosis or dental extraction. On examination there was a 6x5cm firm to hard nonfluctuant mildly tender swelling with trismus and no palpable cervical lymph nodes. Investigations revealed leucocytosis, ESR 45mm and Mantoux 24mm after 48hrs.PNG radiograph showed osteolytic lesion in angle & body of left mandible with CECT showing retro mandibular trigon extension. USG guided FNAC was consistent with tubercular osteomyelitis with Ziehl Neelsen stain positive for acid fast bacilli. He was started on antitubercular therapy for 9 month showing reduction in size and symptom.

Acute Onset Dyspnea Due To Foreign Body (Pill) Aspiration In Left Main Bronchus.

Abstracts: Aspiration of tracheobronchial foreign commonly affects young children and it is uncommon in adults. Bronchoscopy both flexible and rigid is recommended to reveal the aetiology and therapeutic removal of foreign body aspiration. Here we report a case of pill aspiration presenting with acute onset breathlessness in emergency. Investigation of a case revealed left lung atelectasis on chest X-ray. Further workup by bronchoscopy showed an endobronchial mass lesion in left main bronchus causing left lung atelectasis. The obstruction was removed and patient improved promptly.

Oral Squamous Cell Carcinoma in Background of Oral Submucous Fibrosis: A Case Report.

Oral submucous fibrosis (OSMF) is a well-recognized, potentially malignant disorder of the oral cavity that can affect any part of the oral mucosa, characterized by mucosal rigidity of varying intensity caused by fibro elastic transformation of the juxta epithelial layer of connective tissue. OSMF occurs in Indians and other population of the Indian subcontinent with certain oral habits. Betel quid chewing is a popular oral habit with potential links to the occurrence of oral cancer. In patients with submucous fibrosis, the oral epithelium becomes atrophic and thereby becomes more vulnerable to carcinogens. Since the ingredients of betel quid, tobacco are crucial for tumor initiation, promotion and progression, exposure to these toxicants simultaneously has been shown to markedly potentiate the oral cancer incidence in OSMF patients. The rate of malignant transformation of OSMF has been estimated to be 2-10%. Most cases with malignant transformation in OSMF have occurred gradually over a long period of time. This paper presents a case of oral submucous fibrosis turning into malignancy in a 34-year-old male patient.

Non‑syndromic bilateral condylar aplasia: A rare case.

The temporomandibular joint is one of the most complex joints of the human body. It consists of the mandibular condyle, glenoid fossa and the articular eminence of the temporal bone. Aplasia of the condyle is usually seen as part of a syndrome otherwise it is rare. We report a case of bilateral condylar aplasia in a 20‑year‑old male not associated with any syndrome. The patient reported to the department with a chief complaint of the underdeveloped lower jaw. Clinical examination, conventional radiographs, and 3D computer tomography images revealed a complete absence of condyle on the right and left sides.

Diagnosis of interstitial pulmonary fibrosis-an update.

The most common and most lethal type of idiopathic interstitial pneumonia (IIP) is idiopathic pulmonary fibrosis (IPF), which accounts for 55% of lung diseases classified as IIPs. Diagnosis of IPF requires precision and a multidisciplinary approach .Indeed, an early and accurate diagnosis of IPF is critical for a better outcome, especially with the advent of new specific treatments for this disease. The previous guidelines using major and minor criteria for the clinical (i.e. non-pathological) diagnosis of IPF have been discarded, as it is now clear that, in an appropriate clinical setting, the presence of a classical UIP pattern on the HRCT scan is sufficient for a diagnosis of IPF to be made. In the presence of the four classical features, that together accurately identify a Usual interstitial pneumonia (UIP) pattern, a definitive diagnosis of IPF can be made. Guidelines emphasizes the importance of multidisciplinary discussion between clinicians, radiologists and pathologists to improve diagnostic confidence. The course of disease in IPF is unpredictable, but the importance of an early diagnosis is clear, as individuals with less severe lung function abnormalities have a better prognosis.

Role of flexible fiberoptic bronchoscopy in suspected sputum smear negative pulmonary tuberculosis cases at microscopy centre under RNTCP.

Background: Microbiological diagnosis is the main stay for the effective treatment of pulmonary tuberculosis. About 31%of the new cases may be smear-negative for AFB. Difficulties arise when a patient who is suspected of active tuberculosis, both clinically and radiologically, does not produce sputum or when it is available AFB may be negative. Fiberoptic bronchoscopy offers a mean of investigation whereby bronchial secretion and washing can be collected from the most likely abnormal site under direct vision. Aims & Objective: To study the role of flexible fiberoptic bronchoscopy in suspected sputum smear negative pulmonary tuberculosis cases at microscopy centre under RNTCP. Material and Methods: Thirty three patients aged Above 18 years old who were suspected of having pulmonary tuberculosis based on clinical and radiological appearances were prospectively studied. All subjects had at least 2 sputum smear examination which were negative for acid fast bacilli according to the revised national tuberculosis control program (RNTCP). The bronchoscopy was performed transnasally using fujinon bronchoscope by 2 bronchoscopists under local anaesthesia. A thorough examination of bronchial tree was carried out and bronchial aspirate (BA) bronchoalveolar lavage (BAL) bronchial brushing, transbronchial lung biopsy (TBLB) and post bronchoscopy sputum (PBS) were collected. The specimen obtained was placed on slides for Ziehl-Nielsen stain. Bronchial biopsy was performed on abnormal looking mucosa and stained with Eiosin-hematoxylin and Ziehl- Nielsen stains. Results: In total 33 sputum smear negative suspected pulmonary tuberculosis cases, at microscopy centre under RNTCP, early diagnosis of pulmonary tuberculosis was established in 10 (30.30%) cases and in 3 (9.09%) cases diagnosis of malignancy was established. Conclusion: Fiberoptic Bronchoscopy is a useful procedure to establish the diagnosis of pulmonary tuberculosis when sputum smear examination does not show acid fast bacilli. This allows appropriate treatment to be started with confidence.

A Rare Presentation of Osler-Weber-Rendu Disease as Severe Anemia.

Hereditary hemorrhagic telangiectasia (HHT) or Osler-Weber-Rendu disease is a rare fibrovascular dysplasia that makes vascular walls vulnerable to trauma and rupture causing skin and mucosal bleeding. It is of autosomal dominant inheritance characterized by recurrent epistaxis and telangiectasia on the face, hands and oral cavity; visceral arteriovenous malformations (AVMs) and positive family history. Epistaxis is often the foremost manifestation. It is associated with AVMs in several organs. There are possible hematologic, neurologic, pulmonary, dermatologic and gastrointestinal complications. Treatment is supportive and helps prevent complications. We report herein a patient with this syndrome who came to Medicine Unit first at our hospital.

Incisor tooth in the nose: Anecdotal sequel to dog bite in a 3-year-old child.

A 3-year-old male child presented to the casualty with history of unprovoked dog bite over the right lateral wall of nose. He was managed conservatively with antirabies prophylaxis and dressings. He presented after 3 months with a healed wound and the right upper central incisor projecting into the nostril. The Orthopantomogram showed a rotated temporary incisor with the roots of the permanent incisor placed normally. The tooth was extracted intranasally. Among the mutilating dog bite injuries referred to a plastic surgeon, this injury though thought provoking was also comical.

Insilico microarray analysis for helicobacter pylori using gene expression data.

Helicobacter pylori is a Gram-negative, microaerophilic bacterium that inhibits various areas of the stomach and duodenum. It causes a chronic low-level inflammation of the stomach lining and is strongly linked to the development of duodenal and gastric ulcers and stomach cancer. To better understand adaptive mechanisms utilized by H.pylori within the context of the host environment, spotted-DNA microarrays was utilized to characterize in a temporal manner, the global changes in gene expression in response to low pH in the pathogenic H. pylori strain G27. Raw data of this microarray work was available in Stanford Microarray Database. Co-regulated genes may share similar expression profiles, may be involved in related functions or regulated by common regulatory elements. There are different approaches to analyse the large-scale gene expression data in which the essence is to identify gene clusters. This approach has allowed us to (i) determine expression profiles of previously described developmentally regulated genes, (ii) identify novel developmentally regulated genes. The Helicobacter pylori is an important human and veterinary pathogen. In this work raw data of Helicobacter pylori is used as a sample to find out the coexpressed gene.

Changing trends of in vitro antimicrobial resistance patterns in blood isolates in a tertiary care hospital over a period of 4 years.

Context: Multidrug-resistant organisms continue to be a problem for clinicians worldwide. AIMS: To analyze the changing trend of antimicrobial susceptibility patterns in the blood isolates over a period of 4 years in our hospital. Settings and Design: This is a retrospective study done in tertiary care cardiac institute over a period of 4 years. Materials and Methods: We retrospectively analyzed blood culture positive isolates and studied the antimicrobial susceptibility patterns of microorganisms during the period starting from January 2007 to December 2010. Statistical Analysis Used: Statistical analysis was conducted using SPSS for windows version 13.0. Fisher exact test or chi-square test was applied for comparison of categorical variables. P values less than .05 were considered as statistically significant. Results: The rate of blood culture positivity was 3.72%. Gram-negative bacteria were more common than Gram-positive bacteria. There was a gradual increase in Gram-negative bacteria especially Klebsiella pneumoniae and Acinetobacter species. Klebsiella pneumoniae showed a significant increase of resistance to cefoperazone sulbactam (P = .023), piperacillin tazobactam (P < 0.001), imipenem (P < 0.001), and meropenem (P < 0.001) between the first (2007-2008) and second period (2009-2010) of study. The carbapenems resistance is on rise in Gram-negative bacteria including Enterobacteriaceae and non-fermenters. Conclusions: Our findings suggest that there is a definite increase in the multidrug resistant organisms. The data on the changing trends in antibiotic resistance, we believe is an important pillar in our efforts at improving infection control practices.