Abdominoscrotal hydrocele with ipsilateral hydroureteronephrosis in an adult: A case report

Abdominoscrotal hydrocele (ASH) is very rare in adults and difficult to suspect on clinical examination. ASH is a very unusual presentation of scrotal hydrocele with extension intra-abdominally through the inguinal canal either communicating to the peritoneal cavity or non-communicating. An ASH is a congenital pathology involving a scrotal hydrocele expanding through the inguinal canal and reaching the abdominal cavity. Here, we present the case of a 25-year-old man admitted with a complaint of pain and lump in the left lower abdomen for 2 months and swelling in the left groin for 2 years. Ultrasound and computed tomography suggest left ASH with left-sided hydroureteronephrosis. A left DJ stent was placed and on exploration, a large cystic mass was seen intraperitoneally extending into the scrotum through the inguinal canal. Excision of the abdominal part and partial excision of the scrotal part were done with eversion of the remaining tunica vaginalis sac. Although ASH is a rare entity, it should always be kept on the list of differential diagnoses during the complaint of large abdominal mass in adults.

Intracardiac Repair in Late Adolescent and Adult Tetralogy of Fallot — Early and Midterm Results from a Tertiary Care Centre

Abstract Introduction: In developing countries like India, it is common for late presentation of Tetralogy of Fallot (TOF) patients to a hospital as compared to that of developed countries. The objective of this study is to analyze the surgical outcome of TOF patients with age > 15 years. Methods: This is a retrospective descriptive study of the surgical outcomes of 45 adult patients undergoing correction for TOF. Epidemiology, symptomology, and preoperative evaluation were performed. Results: Most of the patients were male (33 [73%]). The median age was 21 years. A total of 42 (93.33%) patients had subaortic ventricular septal defect (VSD), while three (6.6%) patients presented with doubly committed VSD. The most common type of right ventricular outflow tract (RVOT) obstruction was combined infundibular and valvular types, accounting for 34 cases (75.5%). Six patients had infundibular RVOT obstruction, while three patients (6.6%) had predominantly valvular pulmonary stenosis. We performed trans-right atrial repair in 33 patients. Right atrium-pulmonary artery approach was used in five patients (11.1%). The most common postoperative complication was right bundle branch block, seen in 14 patients, with a mortality rate of 2% in the early postoperative period. We achieved excellent early and midterm survival results and significant improvement in functions and disease-free quality of life. Conclusion: Intracardiac repair in adult TOF can be performed with low mortality, less residual RVOT obstruction, and need for revision of RVOT far less frequent by using the Jhajhria Infundibular Resection Adequacy Assessment technique (JIRAAT) to assess for adequacy of infundibular resection.

Outcome of Surgical Condition of Neonates who Underwent Surgery: A Prospective Study from a Tertiary Care Center

Background: The neonatal period is a highly vulnerable time for an infant, who is completing many of the physiologic adjustments required for extra- uterine survival. If the neonate has a coexisting pathology which needs surgery, this challenge is magnified. Neonatal surgical conditions are unique in their type because some require early diagnosis, prompt surgery and postoperative care to improve the survival and outcome. Objective: The aim of this study was to know the clinical profile of congenital surgical conditions and to estimate the burden and outcome in special new born care unit. Method: The study population include 138 surgical neonate admitted in special new born care unit, department of paediatrics, Kamla Raja Hospital, Gajra Raja Medical College, Gwalior (M.P.) from April 2017 to April 2018 including six month follow up period. Results: Total admission in special new born care unit were 5378 out of which 138 (2.5%) neonates of surgical condition were admitted in the study period. Incidence of neonatal surgical condition was found to be 8.48%. Surgery was performed in 57 (41.30%) neonates. The Commonest neonatal surgical condition was constituted by gastrointestinal system (39.13%). Among gastrointestinal system anomalies, tracheoesophageal fistula were 28.6% of total gastrointestinal system cases. The most common surgical condition encountered was meningomyelocele, 23.36% of total cases. The survival of neonatal surgical condition in hospital was 52.89% and after six month follow up was 26.08%. The overall mortality with neonatal surgical condition in this study was 73.91%. Maternal age, antenatal care, history of congenital malformation, socioeconomic status, mode of delivery, prematurity, type of admission, single or multiple surgical condition, inotropic and ventilation support, post operative complication were significantly associated with final outcome of neonatal surgical condition. Conclusion: High mortality was found in neonates suffering from surgical conditions. Commonest anomaly includes conditions of gastrointestinal tract. Maternal age more than 35 year, poor antenatal care, prematurity, vaginal delivery, extra mural neonate, multiple surgical condition, inotropic and ventilation support and post operative complications were associated with increased mortality.

Transatrial approach for total correction of tetralogy of Fallot: our centre experience over three years

Background: The objective of this study was to evaluate the early and mid-term outcome of total correction of tetralogy of Fallot (TOF) done through transatrial approach avoiding ventriculotomy with or without transannular patching.Methods: Of 210 patients undergoing total correction for TOF between January 2016 and January 2019, 180 patients were operated via transatrial approach. The ventricular septal defect closure, infundibular resection and pulmonary valvotomy were performed through the right atrium. Age ranged from 12 months to 44 years (mean, 2.6 years), 104 patients were male and 76 patients were females.Results: Three patients (1.67%) died in early post-operative period. Pulmonary complications were seen in 8 (4.44%), septicemia in 1 (0.55%), low output syndrome in 2 (1.10%) and temporary arrhythmias in 6 (3.33%) patients. Reintubation was needed in 3 (1.67%) patients. Early reoperation was needed in 3 (1.67%) patients in view of post-operative bleeding.  There were no mediastinal or deep sternal wound infections. None of our patient had complete heart block. There were no late deaths or late reoperations. Echocardiography before discharge did not reveal significant residual VSD in any patient. The mean right ventricular outflow tract pressure gradient was 28 mmHg (range of 20 to 44 mmHg) which decreased on follow-up echocardiography to 16 mmHg (range of 14 to 24 mmHg) at mean follow up of 23 months. None of our patient had severe pulmonary or tricuspid regurgitation or severe right ventricular dysfunction on follow up.Conclusions: Transatrial repair of TOF is associated with remarkably low morbidity and mortality in our early experience.

Retracted: Management and overview of postoperative chylothorax after congenital cardiothoracic surgery

The article " Management and overview of postoperative chylothorax after congenital cardiothoracic surgery " is retracted by the Editor-in-Chief, on the request of corresponding author and co-authors who informed errors in data collection after departmental review and post hoc analysis. The article is retracted because the results may be affected due to the errors.

Assessment of 25-Hydroxy Vitamin D Status in Patients Suffering from Psoriasis Along with the Comparison of Controls without Psoriasis: A Comparative Study in Northern India Region

Vitamin D level in serum is one such factor which has been found to be relevant in psoriasis so the aim of the present study is to assess the status of 25-hydroxy vitamin D in patients suffering from psoriasis along with the comparison of controls without psoriasis. Methods: The study included 40 cases and 40 controls. 40 outpatients, 30 male and 10 female, diagnosed clinically with psoriasis were enrolled in this study. Clinically diagnosed active psoriasis patients of any severity, aged more than 18 years, who had not been treated with phototherapy or vitamin D the previous 3 months, were enrolled as cases. Age, sex matched volunteers from the same geographical area attending the dermatology outpatient services as an attendee for the patient without any skin ailments were selected as controls. Appropriate informed consent in the local vernacular language was obtained from both cases and controls. Results: There was a statistically significant difference between cases and controls (P<0.0001). Vitamin D deficiency was observed in 78% of psoriasis patients compared with 28% of controls (P<0.001). Vitamin D deficiency was seen in 18 non-obese and 15 obese individuals. We did not find significant differences in vitamin D levels between patients with psoriasis and controls (P = 0.742). Conclusion: Vitamin D deficiency may be common in patients with psoriasis, and vitamin D has a role in immune regulation.

25-Year trends in hypertension prevalence, awareness, treatment, and control in an Indian urban population: Jaipur Heart Watch

Objectives We evaluated trends in hypertension prevalence, awareness, treatment and control in an Indian urban population over 25 years. Trends were projected to year 2030 to determine attainment of World Health Organization (WHO) Global Monitoring Framework targets. Methods Adult participants (n = 7440, men 4237, women 3203) enrolled in successive population based studies in Jaipur, India from years 1991 to 2015 were evaluated for hypertension prevalence, awareness, treatment and control. The studies were performed in years 1991–93 (n = 2212), 1999–01 (n = 1123), 2003–04 (n = 458), 2006–07 (n = 1127), 2009–10 (n = 739) and 2012–15 (n = 1781). Descriptive statistics are reported. We used logarithmic forecasting to year 2030 and compared outcomes to WHO target of 25% lower prevalence and >50% control. Results The age-adjusted hypertension prevalence (%) among adults in successive studies increased from 29.5, 30.2, 36.5, 42.1, 34.4 to 36.1 (R2 = 0.41). Increasing trends were observed for hypertension awareness (13, 44, 49, 44, 49, 56; R2 = 0.63); treatment in all (9, 22, 38, 34, 41, 36; R2 = 0.68) and aware hypertensives (61, 66, 77, 79, 70, 64; R2 = 0.46); and control in all (2, 14, 13, 18, 21, 21; R2 = 0.82), aware (12, 33, 27, 46, 37, 37; R2 = 0.54) and treated (9, 20, 21, 48, 36, 49; R2 = 0.80) hypertensive participants. Projections to year 2030 show increases in prevalence to 44% (95% CI 43–45), awareness to 82% (81–83), treatment to 62% (61–63), and control to 36% (35–37). Conclusion Hypertension prevalence, awareness, treatment and control rates are increasing among urban populations in India. Better awareness is associated with greater control. The rates of increase are off-target for WHO Global Monitoring Framework and UN Sustainable Development Goals.

Effect of Fortification and Additives on Breast Milk Osmolality.

This study evaluated the effect of fortification and commonly used additives on the osmolality of human milk. Osmolality after fortification with milk powder and human milk fortifier increased from 303 mOsmol/kg to 397 and 373 mOsmol/kg, respectively. The maximal increase in osmolality was seen with the addition of calcium gluconate.

A Modified Technique for Umbilical Arterial Catheterization.

A modified technique for umbilical artery catheterization was assessed in babies in whom conventional method failed or if the cord was dry. Success rate attained with the modified technique was 90% (19/21). This modified technique could provide an easier and faster method for successful umbilical arterial catheterization.

Pericardial Effusion in Children: Experience from Tertiary Care Center in Northern India.

Objective:To describe profile and outcome in children with significant pericardial effusion. Methods: Hospital records of 25 children admitted with significant pericardial effusion during January 2010 to March 2013 were analyzed. Results: Thirteen (52%) children had tubercular, 6 (24%) had bacterial, 3 viral, 2 recurrent idiopathic and one had malignant pericardial effusion. Only 3 children in our series required surgical drainage. Conclusions: Echocardiography guided percutaneous pericardiocentesis and pigtail catheter placement was found to be safe and effective.

Purification of a protease inhibitor from Dolichos biflorus using immobilized metal affinity chromatography.

Plant protease inhibitors (PIs) are generally small proteins which play key roles in regulation of endogenous proteases and may exhibit antifeedant, antifungal, antitumor and cytokine inducing activities. Dolichos biflorus (horse gram) is an unexploited legume, which is rich in nutrients and also has therapeutic importance. It contains a double-headed PI, which is an anti-nutritional factor. As there is no report available on its simultaneous removal and purification in single step, in this study, a double-headed PI active against both trypsin and chymotrypsin was purified from Dolichos biflorus to ~14-fold with ~84% recovery using an immobilized metal affinity chromatography (IMAC) medium consisting of Zn-alginate beads. The method was single-step, fast, simple, reliable and economical. The purified inhibitor showed a single band on SDS-PAGE corresponding to molecular mass of 16 kDa and was stable over a pH range of 2.0-12.0 and up to a temperature of 100°C for 20 min. The optimum temperature for trypsin and chymotrypsin inhibitor was observed to be 50°C and 37°C, respectively and pH optimum was pH 7.0 and 8.0, respectively. Thus, IMAC using Zn-alginate beads was useful in simultaneous purification and removal of an anti-nutritional factor from horse gram flour in single step. This procedure may also be employed for purification of other plant PIs in one step.

Comparative study to test efficacy of topical permethrin and oral ivermectin in the management of scabies- a prospective randomized, single blinded controlled study.

Background : Scabies is a contagious intensely pruritic ectoparasitic infestation caused by mite Sarcoptes scabiei hominis. Various treatment modalities are available but topical permethrin and oral ivermectin is considered to be safe and effective in the treatment of scabies. Aim : To compare the efficacy of topical permethrin and oral ivermectin in the treatment of scabies. Material And Methods : It was an interventional study conducted in the out patient department Rohilkhand Medical College and Hospital.100 clinically diagnosed cases of scabies belonging to either sex and from 10-60 yrs of age were selected and divided into two groups. Oral ivermectin was given to group A and topical 5% permethrin was given to the group B and follow up at 1, 2 and 4 weeks of interval. at each visit and cure rate was compared. Results : Permethrin showed the efficacy of 89.1% in completely clearing scabietic lesions at 4 week interval as compared to oral ivermectin which showed 78.5% clearing of lesions in 4 weeks. Thus both the treatment modalities were almost equally effective. Conclusion : Oral ivermectin and topical permethrin both are almost equally effective but permethrine has rapid onset of action.

HIV associated renal disease: A pilot study from north India.

Background & objectives: HIV/AIDS patients may have renal involvement also, however, Indian data are sparse. The present study was done to find the spectrum of renal diseases in HIV/AIDS patients in north India. Methods: In this prospective pilot study, HIV positive patients aged >18 yr were screened for renal involvement [serum creatinine >1.5 mg% and/or significant proteinuria (>500 mg /day)]. Patients who were positive on screening were followed up prospectively and underwent kidney biopsy if indicated. Results: A total of 526 patients were screened, of these, 91 (17.3%) were found to have renal involvement. Group A (Treatment naïve) comprised 392 patients who were not on antiretroviral treatment (ART) and group B (patients on ART) comprised 134 patients. More patients (74/392, 18.9%) in group A had renal involvement as compared to patients in group B (17/134, 12.7%). Of the 91 patients with renal involvement, 26 were followed up and underwent kidney biopsy. Thirteen patients had only proteinuria and another 13 had renal dysfunction with or without proteinuria. Most common histological diagnosis was mesangioproliferative glomerulonephritis (mes PGN) (10/26). Two patients had collapsing FSGS (focal segmental glomerulosclerosis) and three patients had immune complex glomerulonephritis. Seven patients had acute kidney injury, whom six totally recovered from their renal function. All patients with mesPGN tolerated angiotensin converting enzyme (ACE) inhibitors well. There was mixed response of collapsing FSGS to steroids. Both patients with MPGN (membranoproliferative glomerulonephritis) did well on low dose of steroid and ART. Interpretation & conclusions: Renal involvement was found to be common in HIV positive patients (17.3%). A low occurrence of renal involvement found in patients already on ART suggests some renoprotective effect of ART. Our preliminary results showed that collapsing FSGS was not rare in Indian HIV positive population, but classical HIV associated nephropathy was not seen. Longitudinal studies with robust study design and large sample size need to be done to confirm the findings.

Isolation, purification and characterization of alkali and thermo stable Xylanase from bacillus sp. Ks09.

Nine bacterial strains were isolated using xylan rich media. The bacterial strain KS09 was selected on the basis of qualitative and quantitative test. It was identified as Bacillus sp. via physiological, morphological and biochemical characterization. The xylanase was purified to homogeneity from crude extract of Bacillus sp. KS09 using ammonium sulphate fractioning and CM-Sephadex C-50. The final purification fold was 10.20 with a recovery of 36.18%. The enzyme was optimally active at 50°C, pH 7.0 and stable over a broad pH range of 6.0-11.0. The residual activity at 6.0-11.0 pH was 100% even upto 3 h of incubation. The enzyme showed 75, 70 and 60% thermal stability at 50, 55 and 60°C, respectively after 1 h of incubation. The kinetic parameters (Km 22.59 mM; Vmax 76.93 IU/mL) were estimated using Lineweaver-Burk plot for purified xylanase. The xylanase activity was inhibited by all the metal ions applied. The characteristic studies revealed that xylanase including its cellulase free nature, broad pH stability and temperature stability are particularly suited its industrial applications.

Study of Cardiovascular and Pulmonary Responses During Cold Pressor Test (CPT) In Healthy Volunteers.

Acute pain was induced in 35 healthy volunteer males by cold pressor test (CPT) and pulmonary parameters - respiratory rate (RR), tidal volume (TV), inspiratory and expiratory reserve volume (IRV, ERV), inspiratory capacity (IC), vital capacity (VC), forced vital capacity (FVC), FEV1, peak expiratory flow rate and forced expiratory flow rate at 75, 50 and 25% of expired FVC (FEFR 75, 50 and 25%) were measured. Acute pain parameters like pain threshold, tolerance and sensitivity were also recorded. Besides these, the cardiovascular parameters - pulse rate, systolic and diastolic blood pressure, were also measured. Comparisons were made between values recorded before, during and after cold induced pain. There was a significant increase in cardiovascular and pulmonary parameters (RR, TV, IC, IRV, ERV, VC, FVC and FVC1) during the acute pain induced by CPT, reflecting an acute state of responses secondary to sympathetic challenge. The study indicates that alterations in pulmonary and cardiovascular profile form an integral part of multidimensional responses observed during cold induced acute pain.

Celiac Disease Associated with Recurrent Guillain Barré Syndrome.

Celiac disease is associated with multiple extraintestinal presentations, including bone disease, endocrine disorders and neurological deficits. We report a 9 year old girl with celiac disease presenting with recurrent Guillain Barre syndrome (third episode). There was no other clinical manifestation except for refractory iron deficiency anemia. Molecular mimicry explaining the association between these two disorders, is far more interesting.

Apparent hypocortisolism in an infant with prolonged hyperinsulinism.

We report a case of transient hyperinsulinism with hypocortisolemia in a preterm small for date neonate with recurrent hypoglycemia and perinatal stress. Investigation revealed increased Insulin level with subnormal cortisol level even during hypoglycemia. Hypoglycemia resolved by its own by 22nd day of life with normal insulin and cortisol level thereafter.