Unconventional” Causes of Acute Kidney Injury: A Critical Nuance of Interpretation and Intervention

Background: Acute kidney injury (AKI) is one of the most common clinical problems encountered by physicians in day-to-day practice which is associated with increased morbidity and mortality. The incidence of AKI is increasing so the right approach for interpretation of clinical clues and investigation may be lifesaving. Aim: The study aimed to document the variety of unusual cases of AKI and suggest a case-based approach for clinical evaluation and investigations to help physicians treat such cases. Materials and methods: This was a retrospective analysis of medical/electronic records of 10 patients who were admitted in medical wards between January 2020 and June 2021 and diagnosed to have AKI. Results: We present the history, clinical findings, and investigations of 10 patients diagnosed with unusual causes of AKI. Conclusion: It is important for physicians to recognize unusual causes of AKI. A high index of suspicion and timely diagnosis and treatment interventions may bring complete recovery of renal functions in patients of AKI.

Plastic surgery in Ladakh: a novel initiative in trans Himalaya of India

Background: The super speciality care is not available in remote places in India. But the service of the plastic surgery can be taken to the remote district hospital by arranging plastic surgery camps thereby resulting in service to the poor, capacity building of the local doctors and infrastructure development of the remote hospital.Methods: It is a retrospective study, in which the author analysed the feasibility, management, difficulties and achievement of week long, annual plastic surgery camp in remote set up of a district hospital of Ladakh over three year from 2017 to 2019.Results: A total of 341 patients were included in this study of which 108 underwent various surgical interventions. The youngest operated was 5 months old and oldest was 86 years. Wide spectrum of deformity were seen and operated upon. Complication developed in only six patients (5.5%) which were managed successfully at Leh only. The immediate and long term follow-up result show no difference in surgical result as compared to those compared operated outside with negligible financial burden.Conclusions: Keeping in view the positive outcome, it is argued through this paper that such camps should be replicated in other remote locations all over India.

Demystifying prevalence of anemia in female spouses of army personnel in an Army’s Corps zone: A multicentric cross-sectional study

Background: Anemia is an important public health problem all over the world, both in rich and poor countries. The present study is a cross-sectional multicentric study where data from 10 different stations by 16 different medical establishments were collected. Objective: The present study was conducted to determine the prevalence of anemia in female spouses of army personnel in an Army’s Corps zone. Materials and Methods: The total size of the sample was 14,273 which covered female spouses of army personnel of five different formations under an Army’s Corps zone. All the non-pregnant female spouses of army personnel were screened for anemia using hemoglobin level estimation. Uniform instructions for screening were given from the medical branch of Army’s Corps Headquarters to medical units. Results: The prevalence of anemia found in this study was 21.54% which is much below the national prevalence of 55% as per National Family Health Survey-3 data. Conclusions: Our study with a large sample size demonstrates that the prevalence of anemia in female spouses of army personnel is almost half of national prevalence. This is indeed a landmark achievement of the Army Medical Corps where success was achieved in reducing the burden of anemia.

Study of risk factors causing coronary heart disease among army personnel of the rank non-commissioned officers and below in the age group of 20–50 years and its association with prehypertension

Background: Coronary heart disease (CHD) is an acute public health problem both in developed and in developing countries, like India. Assessing the prevalence of CHD in the community is equivalent to assessing the tip of the iceberg. Hypertension is a major risk factor for CHD and hypertension disease prevalence tip of the iceberg in the community is much more obscure. Objective: The objective of the study was to carry out a cross-sectional study among serving Army personnel, comprising healthy non-commissioned officers and other rank personnel to successfully assess the risk factors for CHD and their association with prehypertension. Materials and Methods: Screening of risk factors for CHD among 200 randomly selected participants was carried out. Blood pressure, height, weight, serum total cholesterol, serum triglycerides, serum high-density lipoprotein (HDL), random blood sugar levels, and smoking status were the major risk factors screened. Results: Nearly 63% of Army personnel were found to be having blood pressure commensurate to the range of prehypertension. About 15% were detected to be overweight, 22% had hypercholesterolemia, 5.4% had impaired glucose tolerance (IGT), and 19.2% were current smokers. Higher age, body mass index, high serum triglycerides, low serum HDL, and IGT were found to be independently associated with increased prevalence of prehypertension in multiple logistic regression analysis. Conclusion: Our findings recommend the constant monitoring of CHD risk factors and the formulation of effective preventive strategies for adequate control of alarming incidence.

A comparative study on efficacy and safety of glycopyrronium bromide + salmeterol/fluticasone and tiotropium bromide + salmeterol/fluticasone in hronic obstructive pulmonary disease

Objective: To compare the effect of tiotropium bromide and glycopyrronium bromide in the treatment of chronic obstructive pulmonary disease. Methods: This was an open labeled Randomized controlled trial study. Patients diagnosed with COPD according to the Global Initiative for chronic Obstructive Lung Disease (GOLD) strategy were included in the study. The patients were divided in two groups and each group had 100 patients. Group A- COPD patients on Tiotropium bromide + Salmeterol/Fluticasone; Group B – COPD patient on Glycopyrronium bromide + Salmeterol/Fluticasone. Tiotropium bromide: 18 mcg OD, Glycopyrronium bromide: 50 mcg OD along with Salmeterol 50 mcg/Fluticasone 100mcg was given. Results: The mean age of patients of Group A and Group B was 56.28±7.78 and 57.64±8.06 years respectively. Baseline variables were comparable between the groups. There was significant (p<0.05) difference in PFT parameters between the groups at 12 and 24 weeks except for FEV1/FVC. The mean change was higher in Group B compared to Group A from 0 week to 24 weeks. There was clinical improvement among all the patients in both the groups. Conclusion: Once-daily GLY demonstrated similar effects to TIO when combined with SAL/FP in patients with moderate and severe COPD.

Tubal Endometriosis Presenting As A Mass In Left Iliac Fossa - A Rare Case Report

Endometriosis is common cause of infertility. We report a case of 28 year old female presenting with left iliac fossa lump diagnosed as endometriosis of fallopian tube on histopathological examination.

Diagnosis In A Spit : A Short Review

Salivary diagnostics is a cost effective, minimally invasive procedure. This bio-fluid can be easily collected, transported and stored. There are a variety of conditions where saliva can be used as a diagnostic tool such as measurement of stress, enzyme levels, developmental disease biomarkers and cancer mutations. A number of studies have focused their attention on the assessment and monitoring of oncologic biomarkers in saliva. Modern techniques, chemicals and various equipment have made laboratory investigations of saliva easy and precise. Its clinical applications and analysis has made salivary diagnostics a useful tool in the field of Medicine and Dentistry. The methodology for diagnosis of oral and systemic diseases has been a subject of study by several researchers with the aim of increasing its use as a diagnostic tool.

Indicators of malnutrition in children with cancer: A study of 690 patients from a tertiary care cancer center.

BACKGROUND: Large data pertaining to indicators of malnutrition in children with cancer is lacking from India. In view of this, we prospectively analyzed consecutive de novo childhood patients with cancer presenting at a tertiary care center. MATERIALS AND METHODS: Height and weight of each child (n = 690) were compared with World Health Organization child growth standards‑2006 for that particular age and sex to get weight‑for‑age, height‑for‑age, and weight‑for‑height indices and below 2SD of the reference median on these indices were considered as underweight, stunted, and wasted, respectively. Body mass index (BMI) for age was also analyzed for thinness and obesity. RESULTS: Prevalence of malnutrition based on Z‑score for weight‑for‑age, height‑for‑age, weight‑for‑height, and BMI‑for‑age was 30%, 31%, 35%, and 41%, respectively. Weight‑for‑age (underweight) was significantly associated (P = 0.018) with solid tumors. Height‑for‑age, weight‑for‑age, and BMI‑for‑age were significantly associated (P = 0.007, P = 0.016, and P ≤ 0.001, respectively) with rural community. CONCLUSION: Malnutrition was observed in approximately one‑third of children with cancer. Malnutrition is associated with solid tumors and those coming from rural community. Wasting has a higher prevalence in children with cancer in <5 years of age group.

Adiponectin correlates with obesity: A study of 159 childhood acute leukemia survivors from India.

BACKGROUND: Acute lymphoblastic leukemia survivors are predisposed to obesity. However, the exact underlying mechanisms are not known. AIMS: The study was done to assess the role of biomarkers of obesity in acute leukemia survivors. SETTINGS AND DESIGNS: This is a cross‑sectional study conducted at All India Institute of Medical Sciences in survivors of acute leukemia who had completed treatment at least 1 year before enrollment in this study. MATERIALS AND METHODS: Obesity was studied by determining the body mass index. Potential biomarkers were studied by assessing serum leptin, resistin, and adiponectin by enzyme‑linked immunosorbant assay, and the results were compared in obese versus nonobese survivors. STATISTICAL ANALYSIS: Descriptive analysis for baseline demographic factors and Student’s t‑test for comparing the mean levels of biomarkers among the obese and nonobese survivors. RESULTS: One hundred and fifty‑nine acute leukemia patients were enrolled in this study with a median follow‑up of 36.8 months. The median age was 10 (range: 3–18) years, and 123 (77.3%) patients were males. The overall prevalence of overweight/obesity was 26.4%, and this was similar in acute myeloid leukemia and acute lymphoblastic leukemia sub‑groups (26.2% vs. 27.3%, P = 0.9). Mean serum leptin and resistin were similar in obese and nonobese leukemia survivors (3.7 vs. 2.85 pg/mL, P = 0.064; 8.01 vs. 9.33 ng/mL, P = 0.36). However, mean serum adiponectin was significantly lower in obese leukemia survivors (7.97 vs. 11.5 μg/mL, P = 0.023). CONCLUSIONS: Obese leukemic survivors had lower serum adiponectin levels than nonobese survivors. However, serum resistin and leptin levels were similar in the two groups.

Right to Health for Children.

India is a signatory to UN Convention on Child Rights but the allocation of funds and interventions to address health problems have been insufficient. A rights-based rather than a welfare approach is needed to realize child rights, of which health and education are crucial. The health needs of the newborn (survival), infant (vaccinations, nutrition) and preschool child (infections, development) require particular attention. Health care delivery systems should be made fully functional, programs properly implemented, and accountability ensured at all levels. Basic curative services must be provided free for all children. Functional health literacy should be provided to the underprivileged.

Neonatal Bartter Syndrome.

Bartter syndrome is characterized by hypokalemia, metabolic alkalosis, increased urinary excretion of sodium, potassium and chloride and normal blood pressure. A rare subset of the disorder occurs in the newborn period, which prompts us to report two such cases. Both showed satisfactory response to treatment with indomethacin.

Maxillary sinus tuberculosis various presentations.

Tuberculosis (TB) of the maxillary sinus is rare. We describe the clinical presentation, management and outcome in two human immunodeficiency virus (HIV) seronegative patients with histopathologically confirmed maxillary sinus TB. One of the patients who presented earlier in the course of the disease could be managed with antituberculosis treatment alone, while the other who presented late required surgical intervention as well.

Oroxylum indicum– a medicinal plant of North East India: An overview of its nutritional, remedial, and prophylactic properties.

Oroxylum indicum (family: Bignoniaceae) or Broken bones tree, which is distributed throughout India and South East Asia. Oroxylum indicum is known by such regional names as Bhatghila, Tona, Bhut-vriksha, Shyonaka, and Hanyu pinyin. Over the past two decades, many reports have appeared in mainstream scientific journals describing its nutritional and medicinal properties. While much of this recent enthusiasm indeed appears to be justified, it is critical to separate rigorous scientific evidence from anecdote. The present review provides the complete information about literatures of Oroxylum indicum as botanical descriptions, vernacular names, biological activity of plant parts, ethanomedicinal uses and current status of research with scope of investigation of Oroxylum indicum for future research. The structures of twenty eight isolated compounds from different parts of Oroxylum indicum with IUPAC names, molecular formula, formula weight, melting points were also reported in this study.

Lornoxicam versus diclofenac sodium in acute renal colic: a prospective randomized trial.

Background: Acute renal colic is excruciatingly painful event, opioid analgesics and nonsteroidal anti-inflammatory drugs remain the mainstay of treatment for acute renal colic. This study compares diclofenac and lornoxicam in their efficacy to relieve pain of renal origin. Methods: Prospective, randomized, double blind clinical study including eighty patients with renal pain admitted in emergency department of a tertiary care teaching hospital. Parameters were observed at baseline and after 15, 30, 60, 180 minutes and 5hrs of drug treatment. The efficacy of the drug was measured by observing: Pain score, onset & duration of action, rescue drug use, global patient and physician impression. Results: Both drugs are effective in relieving pain of renal origin (p<0.05) and maintaining it over time as well. When decrease in value of pain score compared between two groups at various interval there was statistically significant (p<0.05) decrease in pain score only at 15 minutes in lornoxicam group showing this slightly more effective in early phase compared to diclofenac. In either group there is no statistically significant difference regarding onset of action, duration of action and side effect profile. Conclusions: Both the drugs are equally effective and safe in renal colicky pain with added advantage of lornoxicam being more effective in early period.

Use of polycarbonate plastic products and human health.

As plastic and plastic products are being used in day to day at the cost of environment pollution, the human and wild life health and has become a global concern. Researchers found link between abnormal liver enzymes in the people and Bisphenol-A (BPA). Changes in insulin resistance, reproduction system, cardiovascular and brain function are also reported. BPA is used in the production of epoxy resins, polycarbonate resins, and polyester resins. BPA can leach out of certain plastic products including variety of modern goods, reusable food storage containers, eyeglass lenses, white dental fillings, sealants, medical equipments etc. In the body, BPA behaves as an estrogen receptor agonist and mimics estrogen hormone. Bisphenol-A (BPA) is a widespread endocrine-disrupting chemical (EDC) used as the base compound in the manufacture of polycarbonate plastics. Children and unborn and new born babies are at high risk of unwanted effects of BPA. Children suffer from chronic exposure to bisphenol A with manifestation of gastrointestinal problems, adrenal stress, immune dysfunction, toxic over load and neurological disorders. Some study in Japan has observed that more BPA can leach from polycarbonate products that have been scratched or is more than 4 years old or used bottles that have been subjected to bottle brushing or dishwashing and sterilization. People exposed to higher levels of BPA due to use of plastic food and beverages containers are more likely to develop cardiovascular diseases, diabetes and metabolic disorder. Recent studies have suggested that BPA exposure may have a role in the development of weight gain, insulin resistance, pancreatic endocrine dysfunction, thyroid hormone disruption, and several other mechanisms involved in the development of diabetes. Urinary BPA levels are found to be associated with diabetes mellitus independent of traditional diabetes risk factors. There is a concern of exposure of BPA to pregnant women that can affect the development of offspring in the womb. It is considered that women may be placing their fetuses at the risk by having dental sealants applied during pregnancy. Public should be educated about the use of plastic and plastic products which can prove to be hazardous and risk factor to many health problems of human and wild life.