Correlation Between Optical Coherence Tomography Angiography Findings at 3 to 6 Weeks and Functional Outcome at 3 Months Following Acute Ischaemic Stroke Due to Extracranial Carotid Artery Atherosclerotic Disease.

We wanted to evaluate if optical coherence tomography angiography OCTA findings could predict the functional outcome in extracranial carotid artery atherosclerotic disease (ECAD) associated stroke. This exploratory study was performed on adults with acute ischaemic stroke due to ECAD at 3-6 weeks following stroke onset with risk factor matched controls without carotid artery stenosis. Twenty-three stroke patients (cases) and 23 controls were enrolled. There was significant difference between cases and controls in deep vessel density at the macula (p = .0007) and in radial peripapillary capillary perfusion density (RPCPD) at the optic nerve head (ONH) (p = .0007). Statistically significant difference was noted in the total superficial vessel density (SVD) at the macula (SVD within 1 standard deviation [SD] versus SVD beyond 1 SD of control data) in the ipsilateral eye and functional outcome at 3 months (poor versus very good outcome, modified Rankin scale [mRS] 0-1 versus mRS 2-6, respectively; p = .0361). There was statistically insignificant correlation between the RPCPD at the ONH and the National Institutes of Health Stroke Scale score at admission, mRS at discharge, and mRS at 3 months following stroke onset (r = .33, r = .35, r = .39; p = .11, p = .09, p = .06, respectively). The findings of this exploratory study suggested that OCTA findings may predict 3 month outcomes in cases of ECAD-related stroke and could be useful in decision making in future intervention studies as to whether intervene or not in patients having critical or non-critical ECAD for preventing stroke.

Application of advanced causal analyses to identify processes governing secondary organic aerosols.

Understanding how different physical and chemical atmospheric processes affect the formation of fine particles has been a persistent challenge. Inferring causal relations between the various measured features affecting the formation of secondary organic aerosol (SOA) particles is complicated since correlations between variables do not necessarily imply causality. Here, we apply a state-of-the-art information transfer measure coupled with the Koopman operator framework to infer causal relations between isoprene epoxydiol SOA (IEPOX-SOA) and different chemistry and meteorological variables derived from detailed regional model predictions over the Amazon rainforest. IEPOX-SOA represents one of the most complex SOA formation pathways and is formed by the interactions between natural biogenic isoprene emissions and anthropogenic emissions affecting sulfate, acidity and particle water. Since the regional model captures the known relations of IEPOX-SOA with different chemistry and meteorological features, their simulated time series implicitly include their causal relations. We show that our causal model successfully infers the known major causal relations between total particle phase 2-methyl tetrols (the dominant component of IEPOX-SOA over the Amazon) and input features. We provide the first proof of concept that the application of our causal model better identifies causal relations compared to correlation and random forest analyses performed over the same dataset. Our work has tremendous implications, as our methodology of causal discovery could be used to identify unknown processes and features affecting fine particles and atmospheric chemistry in the Earth's atmosphere.

Identification and genetic diversity analysis of high-yielding charcoal rot resistant soybean genotypes.

Charcoal rot disease caused by Macrophomina phaseolina (Tassi) Goid is one of the most devastating diseases in soybean in India. During 2018, 226 diverse soybean genotypes were evaluated for genetic resistance under hot-spot conditions. Out of them, a subset of 151 genotypes were selected based on Percent Disease Incidence (PDI) and better agronomic performance. Out of these 151 genotypes evaluated during 2019, 43 genotypes were selected based on PDI and superior agronomic performance for further field evaluation and molecular characterization. During 2020 and 2021, these forty-three genotypes, were evaluated for PDI, Area Under Disease Progress Curve (AUDPC), and grain yield. In 2020, genotype JS 20-20 showed least PDI (0.42) and AUDPC (9.37).Highest grain yield was recorded by the genotype JS 21-05 (515.00 g). In 2021, genotype JS 20-20 exhibited least PDI (0.00) and AUDPC (0.00).Highest grain yield was recorded in JS 20-98 (631.66 g). Across both years, JS 20-20 had the least PDI (0.21) and AUDPC (4.68), while grain yield was highest in JS 20-98 (571.67 g). Through MGIDI (multi-trait genotype-ideotype distance) analysis, JS 21-05 (G19), JS 22-01 (G43), JS 20-98 (G28) and JS 20-20 (G21) were identified as the ideotypes with respect to the traits that were evaluated. Two unique alleles, Satt588 (100 bp) on linkage group K (Chromosome no 9) and Sat_218 (200 bp) on linkage group H (Chromosome no 12), were specific for thetwo resistant genotypes JS 21-71and DS 1318, respectively. Through cluster analysis, it was observed that the genotypes bred at Jabalpur were more genetically related.

Inclusion body myositis and dysphagia. Presentation, intervention and outcome at a swallowing clinic.

OBJECTIVE: This study reviewed patients with inclusion body myositis who were referred for assessment of dysphagia at a tertiary swallow clinic. It describes symptoms at presentation, imaging and management strategies. METHOD: A retrospective review of electronic patient records was performed between 2016 and 2020. RESULTS: Twenty-four patients were included, with a mean age of 72 years. Baseline modified Sydney Swallow Questionnaires identified problems with hard or dry food, food sticking, and repeated swallowing. Twenty-two patients had a Reflux Symptom Index score that could indicate significant reflux. Video swallow identified specific problems, including tongue base retraction (96 per cent) and residual pharyngeal pooling (92 per cent). Seven patients (30 per cent) had features of aspiration on imaging despite a median penetration-aspiration scale score of 2. Four patients received balloon dilatation, and two patients underwent cricopharyngeal myotomy. CONCLUSION: This study helped to profile features of dysphagia in patients with inclusion body myositis. More evidence is needed to determine the most effective management pathway for these patients.

Snapping Sartorius tendon due to a medial knee ganglion: an unusual cause of medial knee pain.

Snapping of knee could be due to plethora of causes. We describe a case of snapping of Sartorius over a medial knee ganglion that was treated successfully by ultrasound guided aspiration with complete resolution of symptoms.

Intrasynovial spindle cell lipoma of the deep flexor of the middle finger causing intermittent carpal tunnel syndrome-case report and review of the literature.

Carpal tunnel syndrome (CTS) represents the most common entrapment neuropathy of the upper extremity. Intermittent CTS has been reported in the surgical literature and usually, related to masses associated to flexor tendons. We describe a patient with an intrasynovial lipoma involving the deep flexor of the middle finger causing intermittent CTS and snapping on flexion-extension.

Hearing outcomes of cochlear implant recipients with pre-operatively identified cochlear dead regions.

Objectives: To determine how patients who did not meet UK TA166 NICE criteria for cochlear implantation (CI) but were subsequently found to have cochlear dead regions (DRs) performed with CI.Methods: A retrospective review of medical records was performed on CI recipients: 152 controls and 40 in the DR group. Of these, 34 pairs were matched by pre-operative Bamford-Kowal-Bench (BKB) scores and compared.Results: The forty DR patients had a median age at implantation of 56 years. Their mean pre-operative BKB score of 23% increased to 78% after CI. Thirty-seven experienced improvements in BKB scores. In matched case-control analysis, the improvement in mean BKB score with CI was no different (p = 0.19) between the DR group and control group; a similar proportion of patients benefitted in each group.Discussion: This study is the largestreport to date of performance of patients with DRs, before and after CI. The DR group gain similar benefit as the controls.Conclusion: Patients with DRs, who did not meet TA166 NICE criteria, received the same benefit as those who did. TEN testing to detect DRs should be included in routine CI work-up where standard criteria are not met.

Clinico-epidemiological study of low birth weight newborns in the Eastern part of Nepal.

Low birth weight (LBW) remains an important cause of newborn morbidity and mortality. A hospital based prospective and descriptive study was conducted at Paediatric wards, Nursery, Neonatal intensive unit (NICU) and Post natal ward during period of June to October 2010 to note the clinico-epidemiological profile of Low Birth Weight (LBW) newborns. Incidence of the LBW babies in our hospital was 14.45%; more than four fifth (82.2%) baby's mothers were primigravida. Eighty two percent mothers had unbooked pregnancies. Twenty and half percent LBW babies were twins. The mean duration of hospital stay of the subject was 7.4 (± 5.5) days. The mean birth weight of LBW babies was 1648 (± 344) grams. Clinical sepsis, non physiological jaundice and hypoglycaemia were the three most common complications of LBW babies. Antibiotics, oxygen and phototherapy were the three commonest modes of therapy. Majority of children (82.0%) improved and were discharged. Birth weight and gestational age were significantly different between survivors and babies who expired. Primigravida and lesser antenatal visits were important risk factors for Low birth weight babies. Birth weight, gestational age, apnoea and mechanical ventilation were the predictors of outcome.

Oral zinc supplementation for reducing mortality in probable neonatal sepsis: a double blind randomized placebo controlled trial.

OBJECTIVE: To study the role of Zinc in the treatment of neonatal sepsis. DESIGN: Double blind, randomized, placebo controlled trial. SETTING: Tertiary Care Hospital. PARTICIPANTS: 614 neonates with probable neonatal sepsis. INTERVENTION: The drug group (n=307) received 1mg/kg/day of elemental zinc, and placebo group (n=307) received the placebo, in addition to antibiotic therapy and supportive care, till the final outcome (discharge/death). OUTCOME MEASURES: Decrease in mortality rates (primary outcome), duration of hospital stay and need of higher lines of antibiotic therapy (secondary outcomes) were tested. RESULTS: Baseline characteristics of the two groups were similar. No statistically significant differences between drug and placebo group were found in mortality rate (9.77% vs 7.81%; P=0.393), mean duration of hospital stay (142.85 ± 69.41 hrs, vs. 147.99 ± 73.13 hrs; P=0.841), and requirement of higher lines of antibiotic therapy (13.35% vs 12.05%, P=0.628) after supplementation. CONCLUSIONS: This study does not report decrease in mortality rates, duration of hospital stay and requirement of higher lines of antibiotic therapy following zinc supplementation in neonatal sepsis.

Adverse drug reactions to antimicrobial agents in a tertiary care hospital in Nagpur.

Adverse drug reactions are a major cause of hospital admission and in-hospital morbidity. Antimicrobial agents are one of the most commonly prescribed groups of drugs leading to adverse drug reactions. But, limited data is available from hospital settings in our country. Hence, it is important to understand the characteristics of adverse reactions associated with their use. This study was planned to detect the adverse drug reactions through spontaneous reporting system and analyse them using standard assessment scales. It is an observational, prospective study performed in patients attending outpatient department, in-patient department and casualty of tertiary care hospital from 1st June 2005 to 31st May 2009. Patients were examined for adverse drug reactions by spontaneous adverse drug reactions reporting system. Among 2639 total adverse drug reactions reported, 1315 (49.82%) were due to antimicrobial agents. The agents most frequently associated with adverse drug reactions were cotrimoxazole (19.54%), ampicillin (18.25%), rifampicin (6.6%) and azithromycin (5.3%). It is observed that commonly used drugs like antimicrobial agents were causing maximum adverse drug reactions. This study provides a database of adverse drug reactions due to common drugs, which will help clinicians for optimum and safe use of these drugs.

Awareness and knowledge of cervical cancer and its prevention among the nursing staff of a tertiary health institute in Ahmedabad, Gujarat, India.

BACKGROUND: Carcinoma of the cervix is the second most common cancer in women worldwide, while it is the commonest cancer among Indian women. Awareness regarding cervical cancer and its prevention is quite low amongst Indian women. The Pap test is a simple and cost effective technique for early diagnosis of cervical cancer. It is necessary to make nursing staff aware of cervical cancer, so that they can impart knowledge regarding cervical cancer and its prevention to the general public. AIMS AND OBJECTIVES: (1) To assess the knowledge level regarding symptoms, risk factors, prevention and screening of cervical carcinoma among nursing staff. (2) To find out the behaviour of respondents regarding prevention and screening of cervical carcinoma. MATERIALS AND METHODS: A cross-sectional interview-based survey regarding knowledge levels about cervical carcinoma was conducted among the nursing staff from one of the tertiary health institutes of Ahmedabad, India. A structured questionnaire with multiple choices was used for data collection. Provision for open-ended responses was also made in the questionnaire. Department-wise stratification was carried out, and thereafter 15% of the total nursing staff from all departments were selected randomly so as to include a total of 100 nurses in the current study. Data entry was done in Microsoft Excel. SPSS statistical software was used to generate statistical parameters like proportion, mean, standard deviation, etc. The Z test was used as a test of significance, and a P value of <0.05 was considered as the level of significance.

Poly I:C induced microglial activation impairs motor activity in adult rats.

Polyinosinic:polycytidic acid (poly I:C) is a synthetic double stranded RNA, which mimics with viral genome and mediates immune activation response similar to double stranded RNA virus infection into the brain. Microglial cells are the immune competent cells of the central nervous system having Toll like receptors-3 on their surface. Upon establishing that poly I:C infusion into the brain causes microgliosis by creating a viral infection model, the present study was designed to evaluate the effects of microglial activation following poly I:C infusion on motor activity. We infused 100 microl of 1% solution of Poly I:C in TBE buffer directly into the lateral ventricle and TBE buffer as vehicle to controls. A significantly higher microglial cell count as compared to control on 2, 3 and 7 days post infusion was recorded. Motor activity and microglial cell count was assessed in both controls and poly I:C infused rats on 1, 2, 3, 7, 14, 21 and 28 days post infusion. A significant decrease in motor activity and motor coordination occurred with respect to control. The results clearly demonstrate that microglial activation has a direct relevance with decreased motor activity. Findings could also have their importance in understanding the role of microglial cells on behavioral aspects in viral diseases.

Effects of co-exposure of benzene, toluene and xylene to Drosophila melanogaster: alteration in hsp70, hsp60, hsp83, hsp26, ROS generation and oxidative stress markers.

Benzene, toluene and xylene are monocyclic aromatic hydrocarbon compounds, used both as individual compound and as mixtures, in industry as well as household. Previous studies involving exposures to these compounds, individually, have shown that benzene was more toxic compared to toluene or xylene. Here, we tested a working hypothesis that toluene and/or xylene in a mixture containing benzene affect benzene induced toxicity in a non-target organism, Drosophila melanogaster. We exposed D. melanogaster larvae transgenic for hsp70, hsp83 or hsp26 and wild type (Oregon R strain) larvae to 25.0-100.0mM benzene, 25.0-100.0mM toluene and 25.0-100mM xylene, individually or in mixtures. Subsequently, we examined the expression of stress genes (encoding heat shock proteins, hsps), generation of reactive oxygen species (ROS), induction of anti-oxidant stress markers and emergence of flies under treatment as well as control conditions. We observed that all these endpoints were significantly altered in all the treatment groups compared to their respective controls. However, the magnitude of toxicity of a benzene-toluene (BT) or benzene-xylene (BX) or benzene-toluene-xylene (BTX) mixture was significantly lower in the organism than that of individual chemical. Our results also show the modulation of toluene toxicity by xylene. Present study suggests antagonistic effect of xylene and toluene on benzene toxicity and additive/synergistic effect of xylene on toluene induced toxicity. Thus, expression of stress genes may be used as an assay for detection of early cellular toxicity. Further, our study supports the use of Drosophila as an alternative animal model for first tier screening of adverse effects of chemical mixtures.

Phalange metastasis from carcinoma of alveolus.

Metastatic involvement of a phalanx by head and neck cancers is rare. We report a case of a 66-year-old man with squamous cell carcinoma of the alveolus who had no residual disease or local recurrence after treatment but presented with metastasis to the middle phalanx of the middle finger.

Clinical profile and outcome of children presenting with poisoning or intoxication: a hospital based study.

Poisoning is a common preventable cause of morbidity and mortality in children. Most of the poisoning in children less than 5 years of age is accidental. Objective of the study was to study the clinical profile and outcome of childhood poisoning and intoxication. This was a retrospective study done in patients who were admitted in pediatric wards and pediatric intensive care unit (PICU) of BP Koirala Institute of Health Sciences with history of ingestion of poison or intoxication or envenomation firom January 2005 to June 2008. The data collected were analyzed with SPSS 12.0 software. There were 122 children enrolled in study. Male: female ratio was 1.4:1. The mean age of presentation was 5.8 years. Among 122 patients, 43.4% received pre-referral treatment in the form of gastric lavage, atropine etc. Organophosphorus poisoning was the commonest poisoning seen in 55 (45.1%) patients followed by hydrocarbon 12 (9.8%), mushroom 10 (8.2%) and organochlorine 10 (8.2%) poisoning. During treatment, 50.0% received antidotes. 55.7% received antibiotics, gastric lavage and anticonvulsants were required in 43.4% and 13.9% respectively. Overall survival was 87.4%. The time interval between intoxication and presentation to hospital, mean Glasgow Coma Scale (GCS) and presence of coma (GCS <8) were significantly different between survivors and expired cases. In conclusion, organophosphorus is the commonest agent involved in childhood poisoning. Overall, the outcome is good with 87.4% survival in our hospital. The time gap between the poisoning and presentation to hospital and presence of coma predict mortality.

Endovascular management of ruptured cerebral mycotic aneurysms.

The purpose of this investigation was to evaluate the current endovascular management of cerebral mycotic aneurysms. We report the retrospective evaluation of data of patients with cerebral mycotic aneurysms treated with endovascular approach. Thirteen consecutive patients with cerebral mycotic aneurysms were treated between April 2001 and March 2007. There were seven men and six women with ages ranging from 20 to 52 years (mean age 33 years.). All 13 patients had rheumatic heart disease (RHD) with endocarditis. The aneurysms were located within the distal cerebral circulation (n = 12) or in the circle of Willis (n = 1). All were ruptured aneurysms. Distal aneurysms were treated by parent vessel occlusion. Proximal saccular aneurysms were selectively treated. Endovascular treatment was technically successful in all patients. No patient had a rebleed after embolization during the clinical follow-up. Two patients deteriorated and died after endovascular treatment. Repeat CT scan showed increased mass effect because of earlier intracerebral bleed. The late clinical outcome in the other 11 patients was normal neurological status (n = 8) or permanent disability that was related to the initial stroke (n = 3). Endovascular approach is a reliable and safe technique for management of cerebral mycotic aneurysms.

Internal iliac artery ligation for arresting postpartum haemorrhage.

OBJECTIVE: To study the role of internal iliac artery ligation (IIAL) in arresting and preventing postpartum haemorrhage (PPH). DESIGN: Retrospective chart review of women undergoing therapeutic IIAL for PPH or prophylactic IIAL for risk of PPH. SETTING: Tertiary care hospital in Pune, India. SAMPLE: Women admitted to King Edward Memorial (KEM) Hospital, Pune, India, who underwent IIAL to control or prevent PPH. METHODS: Bilateral IIAL was performed in all women. MAIN OUTCOME MEASURES: Need for re-laparotomy or hysterectomy to control haemorrhage, complications of the procedure. RESULTS: Out of 110 women who underwent IIAL, 88 had therapeutic IIAL for PPH from atony (36), genital tract injury (23), placenta praevia (21), placental abruption (4), uterine inversion (3) or coagulopathy (1). Hysterectomy was performed after IIAL failed to arrest haemorrhage in 33 (39.3%) of 84 women (excluding 4 with vaginal lacerations). Hysterectomy was more likely with uterine rupture (79%) than with nontraumatic PPH (up to 27%). Failure to control haemorrhage by IIAL was evident immediately, and bleeding arrested by IIAL did not recur to require later laparotomy in any woman. Out of 22 women at high risk for PPH undergoing prophylactic IIAL at caesarean section, none had subsequent haemorrhage. One woman had an iliac vein injury that was repaired with no further morbidity. There were no ischaemic complications either during inpatient stay or up to 6 weeks. CONCLUSIONS: IIAL is useful in the treatment and prevention of PPH from any cause. Early resort to IIAL effectively prevents hysterectomy in women with atonic PPH. In traumatic PPH, IIAL facilitates hysterectomy or repair as indicated and prevents reactionary haemorrhage.

Heparin or local thrombolysis in the management of cerebral venous sinus thrombosis?

SUMMARY: Patients with acute cerebral venous sinus thrombosis treated with Heparin or in situ thrombolysis in our department were evaluated in an attempt to rationalize treatment with heparin or thrombolysis. 279 patients with angiographically proven acute cerebral venous sinus thrombosis were included in the study. Patients were classified into mild and severe clinical grade. The study was divided into three phases. Phase I included 27 patients treated with systemic heparin. Phase II included 72 patients, 30 in severe grade and 42 in mild. 26 were thrombolysed with 14 in severe and 12 in mild grade. Phase III included 180 patients treated according to a defined protocol. 133 were in mild grade and 47 in severe. 67 patients were thrombolysed. In the thrombolysed group 27 patients were in mild grade and 40 in severe. 113 patients were treated with systemic heparin. Following acute management all were anticoagulated for six months. The baseline characteristics were found to be same in all three phases. On comparison of outcome in Phase III with Phase 1 the likelihood ratio was found to be statistically significant in favor of Phase III (p<0.0001). The likelihood ratio was found to be statistically significant in mild and severe clinical grade in favor of thrombolysis in Phase III (p 0.039 in mild and p 0.00001 in Severe clinical grade). This ratio was insignificant (p=0.716) for intracranial bleed; however, local puncture site bleeding was found to be significant in the thrombolysed group (0.00005).