Giant Cell Tumor in the Distal End of the Ulna Managed by Darrach's Procedure: A Case Report.

Giant cell tumors (GCTs) are rare, benign, and locally invasive tumors, typically found in the epiphysis of long bones, most commonly at the distal femur and proximal tibia. To date, GCTs of the distal end of the ulna have been very rare. We document a case of a 38-year-old female with a distal ulna GCT, managed with en-bloc resection of the tumor with flexor carpi ulnaris and extensor carpi ulnaris tendon stabilization. The main aim of the GCT treatment is to prevent local recurrence and to maintain the function of the limb. Physical therapy was also given to the patient which helped in relieving pain, reducing edema, and increasing strength and range of motion. The patient was able to perform activities of daily living with the help of physical therapies and exercises. More research is needed to determine if broad excision of the distal ulna alone is a successful therapy for primary bone cancers affecting the distal ulna, including GCTs.

The Rare Occurrence of Giant Cell Tumor of the Proximal Tibia With Pathological Fracture in an Elderly Male: A Case Report.

Giant cell tumor of the bone (GCTB) is a benign bone tumor that can occasionally progress to malignancy, usually in chronic cases. It is a common benign and aggressive bone tumor that affects patients aged between 20 and 45 years. The most common location is the knee joint. It manifests as a painless or occasionally painful swelling over the affected area. A case of giant cell tumor (GCT) of the proximal tibia in a 72-year-old male is reported here, which was difficult to diagnose as it is rarely found in the geriatric age group. The patient came with a chief complaint of pain and swelling over his left knee for two months with a history of trauma to the knee a couple of times. On clinical examination, the patient had grade 3 tenderness and swelling on the anterolateral aspect of the knee extending toward the proximal tibia. The swelling was well-defined, smooth, firm, and uniform in consistency with dimensions of 15 cm × 12 cm. The swelling was moveable sideways, and the movement of the knee suggested that it was not attached to the underlying bone. As per the age and history of the rapid-growing lesion, we suspected malignancy, but clinical findings were pointing toward benign tumor. X-ray of the affected knee was done, which revealed a soft tissue mass with the involvement of the bone. Magnetic resonance imaging (MRI) of the knee revealed a soft tissue mass with the cortical breach. An open biopsy was done for the confirmation of the diagnosis, which was later reported and confirmed as a giant cell tumor of the proximal tibia. As bone tumor is associated with a cortical breach and pathological fracture, it was classified under Campanacci grade 3, for which an en bloc resection and open reduction and internal fixation with plate osteosynthesis with bone cementing and bone grafting were done followed by knee bending physiotherapy and gradual weight-bearing. Finally, the knee function was improved with pain relief.

SCOPE: Surveillance of COVID-19 in pregnancy- results of a multicentric ambispective case-control study on clinical presentation and maternal outcomes in India between April to November 2020.

OBJECTIVE: To determine the clinical manifestations, risk factors, treatment modalities and maternal outcomes in pregnant women with lab-confirmed COVID-19 and compare it with COVID-19 negative pregnant women in same age group. DESIGN: Multicentric case-control study. DATA SOURCES: Ambispective primary data collection through paper-based forms from 20 tertiary care centres across India between April and November 2020. STUDY POPULATION: All pregnant women reporting to the centres with a lab-confirmed COVID-19 positive result matched with controls. DATA QUALITY: Dedicated research officers extracted hospital records, using modified WHO Case Record Forms (CRF) and verified for completeness and accuracy. STATISTICAL ANALYSIS: Data converted to excel files and statistical analyses done using STATA 16 (StataCorp, TX, USA). Odds ratios (ORs) with 95% confidence intervals (CI) estimated using unconditional logistic regression. RESULTS: A total of 76,264 women delivered across 20 centres during the study period. Data of 3723 COVID positive pregnant women and 3744 age-matched controls was analyzed. Of the positive cases 56·9% were asymptomatic. Antenatal complications like preeclampsia and abruptio placentae were seen more among the cases. Induction and caesarean delivery rates were also higher among Covid positive women. Pre-existing maternal co-morbidities increased need for supportive care. There were 34 maternal deaths out of the 3723(0.9%) positive mothers, while covid negative deaths reported from all the centres were 449 of 72,541 (0·6%). CONCLUSION: Covid-19 infection predisposed to adverse maternal outcomes in a large cohort of Covid positive pregnant women as compared to the negative controls.

HRSA-Funded MCH Pipeline Training Program: Advancing the MCH Pipeline and Workforce Through Research Collaborations.

PURPOSE: Presently, there are six undergraduate HRSA-funded MCH pipeline training programs (MCHPTP) in the nation and they have gained significant momentum since inception by recruiting, training and mentoring undergraduate students in a comprehensive MCH-focused approach. This article describes the outcomes from the 6 training programs; and primarily Baylor College of Medicine-Texas Southern University (BCM-TSU's) collaborative strategy focusing on the MCH research training and outcomes, which align with HRSA's MCH bureau's missions. DESCRIPTION: Each MCHPTP offers trainees interdisciplinary MCH research experiences through intra/inter-institutional collaborations and partnerships, but BCM-TSU's MCHPTP was the only one with the primary focus to be research. As a case study, the BCM-TSU Program developed an innovative research curriculum integrated with MCH Foundations Course that comprised 2 hour weekly meetings. Students were split into collaborative research groups of 4-5 students, with multidisciplinary peer-mentors, clinical fellows and MCH research faculty from institutions at the world-renowned Texas Medical Center. ASSESSMENT: Since the inception of the MCH mentorship programs, all six MCHPTPs have enrolled up to 1890 trainees and/or interns. BCM-TSU Program trainees are defined as undergraduate students in their 1st or 2nd year of college while research interns are upper classmen in their 3rd or 4th year of college. The case study showed that BCM-TSU Program trainees demonstrated outstanding accomplishments in the area of research through primary and co-authorships of 13 peer-reviewed journal publications by 78 trainees, over a period of 3 years, in addition to dozens of presentations at local, regional and national conferences. CONCLUSIONS: The research productivity of students in the six MCHPTPs is strongly indicative of the success of integrating MCH research mentoring into MCH didactic training. The development of a diverse and robust MCH mentorship program promotes and strengthens research activities in areas of high priority such as addressing health disparities in MCH morbidity and mortality in the U.S.

Effects of Illicium verum Hook. f. (Chinese herb) enriched diet on growth performance, immune response and disease resistance in Catla catla [Hamilton] fingerlings against Aeromonashydrophila.

Our present study investigates the effects of Illicium verum enriched diet on growth performance, immune response and disease resistance in Catla catla fingerlings against Aeromonas hydrophila. Experimental groups, i.e., infected C. catla were fed with 5 g/kg, 10 g/kg and 15 g/kg of I. verum diet for a period of 30 days showed a significant increase in their final body weight (FBW) over control. There was a significant increase (p < 0.05) in total weight gain (TWG), specific growth rate (SGR), feed conversion rate (FCR), protein efficiency ratio (PER), condition factor (CF) and survival rate (SR) in 10 g/kg and 15 g/kg groups compared to control; also from 31 to 60 days these groups showed an enhanced (p < 0.05) complement activity, phagocytic activity, respiratory burst activity and lysosome activity. The experimental group fed with 10 g/kg of I. verum diet showed the least cumulative mortality rate (5%) compared to 5 g/kg (30%) and 15 g/kg (15%) experimental groups and in control (10%) and negative control (75%). Our present study highlights that challenged fish fed with the mid dosage of 10 g/kg showed a significant increase in overall growth performance, non susceptibility to diseases and tolerance against A. hydrophila in C. catla compared to other experimental groups including the group given with high dosage of 15 g/kg. Thus our results suggest 10 g/kg as the optimal dosage of I. verum that can be used to enrich the fish diet for a better performance and effective immunostimulation in commercially important C. catla for its sustainable culture and is reported for the first time.

Success of Maternal and Child Health Pipeline Training Programs: Alumni Survey Results.

INTRODUCTION: The Maternal and Child Health (MCH) Pipeline Training Program, promotes development of a diverse health workforce by training undergraduate students from underrepresented minorities. We aimed to evaluate the success of this program based on three domains: (1) demographic characteristics, (2) academic and career development, and (3) attitudes towards the field of MCH and the training programs among graduates. METHODS: Three domains of success were determined through a collaborative effort between current program directors and the funding agency project officers. The survey with questions related to the three domains was distributed via an online platform to graduates from seven sites (one former site and six current sites). Data were analyzed and presented utilizing descriptive statistics. RESULTS: The survey was distributed to 550 graduates, 162 responded (37% response rate). Demographically, 78% were female, 54% were Black/African American, 22% were Latinx and 83% did not report any disability. Eighty percent of respondents applied to graduate/professional schools, 67% received admission. Graduates often continued to work in MCH fields (70%). Majority felt confident and knowledgeable in the field (89%) and agreed the faculty were supportive at their training sites (90%). CONCLUSION: The study highlights successes in recruiting from underrepresented minorities, particularly Black/African Americans and first-time college goers in the family into the MCH Pipeline Training Programs. Programs were successful in furthering academic and career development for most trainees. Attitudes towards MCH and the training programs were overwhelmingly positive. Continued support of these programs is critical in addressing health disparities and achieving health equity.

MCH Pipeline Training Program: Connecting with Academia to Build Capacity Through Mentoring.

INTRODUCTION: Efforts to recruit and retain diverse Maternal and Child Health (MCH) professionals are of paramount public health significance. Culturally congruent mentorship strategies are key to supporting a successful transition from undergraduate to graduate studies. METHODS: This mixed-method study evaluated a culturally congruent mentorship training used by one of the MCH Pipeline Training programs and described mentorship practices and lessons learned from the six MCH Pipeline programs. A retrospective pre-test post-test survey assessed mentorship competency skills following a mentoring workshop. All MCH Pipeline program leaders completed a questionnaire to elicit responses about mentoring training practices, mentor evaluation strategies, and lessons learned. RESULTS: Maternal and Child Health Pipeline Training Programs supported 1890 undergraduate scholars at universities and institutions nationally. Scholars at six MCH Pipeline Programs participated in MCH education and mentored experiential leadership opportunities in clinical practice, research, and public health education. Qualitative program-level mentor survey themes indicated the importance of creating a reflective space and building mentorship teams. Mean mentor self-assessed improvement in mentor competencies was 14.4 points, 95% CI [10.5, 18.3], p < .001 following completion of a mentoring training workshop implemented by one of the MCH Pipeline programs. DISCUSSION: The Health Resources and Services Administration's Maternal and Child Health Bureau recognized the need to support the development of the next generation of diverse MCH leaders. Pipeline programs that included mentoring workshops and building culturally congruent mentorship teams are two strategies to increase and retain diverse scholars in graduate school and leaders in the public health workforce.

Success of Maternal and Child Health Pipeline Training Programs: Alumni Survey Results.

INTRODUCTION: The Maternal and Child Health (MCH) Pipeline Training Program, promotes development of a diverse health workforce by training undergraduate students from underrepresented minorities. We aimed to evaluate the success of this program based on three domains: (1) demographic characteristics, (2) academic and career development, and (3) attitudes towards the field of MCH and the training programs among graduates. METHODS: Three domains of success were determined through a collaborative effort between current program directors and the funding agency project officers. The survey with questions related to the three domains was distributed via an online platform to graduates from seven sites (one former site and six current sites). Data were analyzed and presented utilizing descriptive statistics. RESULTS: The survey was distributed to 550 graduates, 162 responded (37% response rate). Demographically, 78% were female, 54% were Black/African American, 22% were Latinx and 83% did not report any disability. Eighty percent of respondents applied to graduate/professional schools, 67% received admission. Graduates often continued to work in MCH fields (70%). Majority felt confident and knowledgeable in the field (89%) and agreed the faculty were supportive at their training sites (90%). CONCLUSION: The study highlights successes in recruiting from underrepresented minorities, particularly Black/African Americans and first-time college goers in the family into the MCH Pipeline Training Programs. Programs were successful in furthering academic and career development for most trainees. Attitudes towards MCH and the training programs were overwhelmingly positive. Continued support of these programs is critical in addressing health disparities and achieving health equity.

Impact of Hygrophila auriculata supplementary diets on the growth, survival, biochemical and haematological parameters in fingerlings of freshwater fish Cirrhinus mrigala (Hamilton, 1822).

The present study investigates the effects of Supplementary diet Hygrophila auriculata on the growth, survival, biochemical and haematological parameters of Cirrhinus mrigala. The seaweed was administered to the fish possessing an initial average weight of 14.063 ± 1.828 g. Fish were fed with supplementary diet H. auriculata exhibited significant difference (P < 0.05) in the growth performance, haematological indices such as RBC count, haematocrit volume, haemoglobin, WBC, MCV, MCH and MCHC concentration in contrast to the control after a period of 8 weeks. Also, there were significant differences in biochemical parameters (P < 0.05), between the fish supplemented with dietary H. auriculata extract and the control group. These findings suggest that the administration of H. auriculata extract has a positive effect on the immunological indices and the immune system activity in Mrigal fish.

Placental findings in singleton stillbirths: a case-control study from a tertiary-care center in India.

OBJECTIVES: Placental examination in a case of stillbirth can provide insight into causative/associated factors with fetal demise. The aim of this study was to compare placental and umbilical cord pathologies in singleton stillbirth and livebirth placentas, and to find prevalence of various associated maternal and fetal clinical factors. METHODS: This case-control study was conducted at a tertiary-care center in India over a period of 20 months. About 250 women who delivered stillborn fetus ≥28 weeks' gestation and 250 maternal-age-matched controls were recruited. Sociodemographic and clinical details were noted and placental gross and microscopic examination was done. Placental findings were compared between stillbirth and livebirth (overall), preterm stillbirth and preterm livebirth as well as term stillbirth and term livebirth in six categories - placenta gross, cord gross, membranes gross, maternal vascular malperfusion, fetal vascular malperfusion and inflammatory response. Prevalence of 11 maternal and fetal factors were studied in all categories of placental findings in both livebirth and stillbirth. RESULTS: Placental findings in all six categories were significantly associated with stillbirths (p<0.05). The placental findings associated with stillbirth with highest odds included placental hypoplasia (OR 9.77, 95% CI 5.46-17.46), necrotizing chorioamnionitis (OR 9.30, 95% CI 1.17-73.96) and avascular villi (OR 8.45, 95% CI 3.53-20.25). More than half of the women with stillbirths had medical disorders (n=130, 52.0%) and the most prevalent was hypertensive disorder (n=45, 18.0%). CONCLUSIONS: Changes in placenta are associated with development of stillbirth. Therefore, antenatal investigations to identify placental dysfunction should be investigated to determine whether these reduce stillbirth. Also, placental examination in a case of stillbirth can detect/diagnose many maternal/fetal conditions and thereby can help in preventing future stillbirths.

Seasonal changes in the milt quality of spotted scat, Scatophagus argus: Implications for artificial propagation.

The current study investigated the correlation among sperm production (milt volume, spermatocrit and sperm count), sperm motility characters and biochemical composition of seminal plasma during different seasons to estimate the quality of semen in the Spotted scat (Scatophagus argus). The sperm of 120 males were collected over a period of 2 years seasonally viz., summer, pre-monsoon, monsoon and post-monsoon. During the collection period, it was observed that there were significant (p < 0.05) seasonal variations in the semen quality including sperm motility and production more in the summer season than other seasons. The osmolality of seminal plasma varied from 343.33 to 370.33 mOsm/kg. The pH of seminal plasma elevated from 7.37 to 7.63 during monsoon and summer seasons. The motility of S. argus sperms correlated with the concentration of biochemical compounds viz., Ca2+, Mg+ and Cl- during the summer season. Based on the present observation it could be highlighted that sodium and potassium were negatively correlated (p < 0.01 and p < 0.05) effect on total protein (r = -0.826; -0.956), glucose (r = -0.819; -0.717), cholesterol (r = -0.978; -0.849), AST (r = -0.853; -0.897), ALT (r = -0.970; -0.967), calcium (r = -0.850; -0.697), magnesium (r = -0.852; -0.843) and chloride (r = -0.906; -0.926). In conclusion, many physical and biochemical compositions of S. argus semen improved during that the summer and pre-monsoon season as compared to that of monsoon and post-monsoon. Fertility tests were performed to determine the ability of spermatozoa to fertilize an egg. Highest fertilization (79.92 ± 4.60%) and hatching (80.75 ± 3.89%) rates were observed during summer, while the rates were lowest during monsoon (40.50 ± 4.52%; 53.92 ± 7.38%). This work forms a compiled data for standard semen quality, which in turn will help to select good milters for hatchery production, cryopreservation and assisted breeding programs of this fish.

Study of Lethal Congenital Malformations at a Tertiary-Care Referral Centre in North India.

Lethal congenital malformations (LCMs) are fatal birth defects that are an important cause of fetal/neonatal death. There is a lack of informative data about these malformations in India, a country that shares the maximum burden of neonatal mortality due to congenital birth defects. Therefore, we conducted a retrospective analysis to know the prevalence of LCMs in late pregnancy, to find out associated factor/variables and to evaluate fetal/neonatal outcome of such anomalies; at a tertiary-care referral centre in North India. All deliveries with LCMs after 24 weeks of gestation were included in the study. Data about antepartum history (maternal age, parity, education, socioeconomic status, consanguineous marriage, folic acid intake, any chronic medical disorder, availability of anomaly scan, unplanned pregnancy); intrapartum events (gestational age at delivery, mode of delivery); postpartum events (weight of the baby, gender of the baby); newborn evaluation; and details of hospital stay were recorded from medical record sheet over the duration of one year. We found that anencephaly, severe meningomyelocele, multicystic dysplastic kidneys and non-immune hydrops with major cardiac defects were more prevalent among all LCMs. On the evaluation of the various studied variables, maximum babies with LCMs were born to mothers who were between 20 and 35 years of age, those who were illiterate, belonged to middle/lower socio-economic class, multigravida, and those who had no detailed anomaly scan. We feel that there is an urgent need to formulate a universally accepted definition of LCMs, to identify preventable risk factors and to formulate management strategy for both mother and liveborn baby with LCMs, in order to minimize the hidden burden of these defects in stillbirth/ perinatal/ neonatal mortality statistics.

Percutaneous Tracheostomy in Patients at High Risk of Bleeding Complications: A Retrospective Single-center Experience.

AIMS: To study the bleeding complications in patients undergoing percutaneous tracheostomy and who are at high risk of these complications (due to thrombocytopenia, use of anticoagulant or antiplatelet agents, and difficult anatomy). MATERIALS AND METHODS: A retrospective study was undertaken, which included all patients undergoing percutaneous tracheostomy in the medical intensive care unit (MICU) of Rashid Hospital, Dubai, over a period of 15 months. Percutaneous tracheostomy was performed by senior medical intensivists using the single-tapered dilator technique under fiber optic bronchoscopic guidance. All patients underwent ultrasonographic evaluation of the neck to look for difficult anatomy and to determine the size of tracheostomy tube, etc. Patients were divided into two groups, those who were deemed to be at high risk of bleeding complications were compared with patients without any risk factors for bleeding complications. Other complications such as pneumothorax and tracheal leak were also looked for and were documented, if present. The data were summarized using descriptive statistics and the Fischer's exact test of significance was used for frequency distribution cross tables, at 5% level of significance (p value cutoff <0.05). RESULTS: One hundred and fifty-nine patients underwent percutaneous tracheostomy during the period of study. The age-group of patients ranged from 21 years to 104 years and males were predominant (65.41%). Of the 87 (54.71%) patients with one or more risk factors for bleeding, 53 (60.92%) patients had at least one risk factor for bleeding complications, while 34 (39.08%) had more than one risk factors. Bleeding was seen in total of two patients out of which one patient was in the group at risk of bleeding complications. CONCLUSION: Percutaneous tracheostomy is a relatively safe procedure with very low rate of complications when performed with due precautions. Even in patients deemed to be at high risk of complications, the rate of complications is very low. HOW TO CITE THIS ARTICLE: Sasane SP, Telang MM, Alrais ZF, Alrahma AHNS, Khatib KI. Percutaneous Tracheostomy in Patients at High Risk of Bleeding Complications: A Retrospective Single-center Experience. Indian J Crit Care Med 2020;24(2):90-94.

Association between periodontal disease and gestational diabetes mellitus-A prospective cohort study.

AIM: This study aimed to determine the association between periodontal disease and gestational diabetes mellitus (GDM) and the effect of this association on pregnancy outcome in North Indian population. MATERIALS AND METHODS: A total of 584 primigravidae were recruited at 12-14 weeks of gestation. Their periodontal examination was carried out along with 75 g oral glucose load test at the time of recruitment. GDM was diagnosed as per the DIPSI (The Diabetes in Pregnancy Study group India) guidelines (≥140 mg/dl). Women with normal plasma glucose values underwent a repeat 75 g oral glucose load test at 24-28 weeks of gestation. All patients were followed up for pregnancy outcomes. RESULTS: Of 584 primigravida, 184 (31.5%) had gingivitis and 148 (25.3%) had periodontitis. Overall, 332 (56.8%) pregnant women had periodontal disease. It was associated with GDM with adjusted hazard ratio (aHR) of 2.85 (95%CI = 1.47-5.53). The occurrence of pre-eclampsia was associated with periodontal disease with aHR of 2.20 (95%CI = 0.86-5.60). If primigravidae had periodontal disease along with GDM, the risk of pre-eclampsia had shown increased aHR of 18.79 (95% CI = 7.45-47.40). CONCLUSIONS: The study shows a significant association of periodontal disease with GDM and an increased risk of developing pre-eclampsia due to this association.

"Doctor, are you listening?" Communication about children's mental health and psychosocial concerns.

Effective communication is critical, including in the pediatric primary care setting. Pediatric primary care providers (PPCPs) are in a unique position to address psychosocial and mental health concerns during office visits, and effective communication skills play a crucial role in providing an opportunity for parents and patients to disclose and discuss such concerns. In this article, the authors encourage two relatively simple strategies that have shown potential for enhancing effective communication in pediatric primary care regarding mental health and psychosocial issues: (a) ensure that pediatric residents and practicing providers have access to brief, targeted communications training and (b) strongly promote the use of screening tools both to encourage discussion and to assist in identifying children who may benefit from further assessment and/or treatment. (PsycINFO Database Record

Ultrastructure of sperm of the Spotted scat (Scatophagus argus, Linnaeus, 1766) observed by scanning and transmission electron microscopy.

An investigation was conducted to understand the sperm cell morphology and ultrastructure of Spotted scat (Scatophagus argus) through scanning and transmission electron microscopy. The present study reveals that the sperm of S. argus can be differentiated into three major parts - an acrosome-less spherical head, a short mid-piece, and a cylindrical flagellum. The scat sperm cell had a mean total length of 21.32 ± 1.80 µm with the presence of ovoid electron-dense nucleus. The mean length and width of ovoid nucleus measured 1.44 ± 0.34 and 1.54 ± 0.33 µm, respectively. The structural characteristics of the nucleus were found to be a shallow axial nuclear fossa and centriolar complex. The two centrioles were positioned nearly perpendicular to each other with a conventional "9 + 0" pattern in the proximal centriole. The short mid-piece was located laterally to the nucleus and contains 5 or 6 spherical and unequal-sized mitochondria. The mitochondria were separated from the axoneme by a cytoplasmic canal. The flagellum was inserted at the base of the nucleus with the presence of an axoneme structure of 9 + 2 paired micro tubules. The sperm flagellum had short irregular lateral fins. The present study reveals that Spotted scat sperm can be categorized as being of a "primitive or ect-aquasperm type" and belongs to the teleostean "type I" sperm. This is the first report on the morphology and ultrastructure of sperm in Scatophagidae family.

Response of keloid fibroblasts to Vitamin D3 and quercetin treatment - in vitro study.

Keloid scars continue to pose a challenge to clinicians as the treatment armamentarium lacks a formidable agent to tackle them. We have undertaken an in vitro study based on the mechanism of action of Vitamin D3 and quercetin on isolated keloid fibroblasts. Dose-dependent action on the reduction of cellular proliferation, collagen synthesis and induction of apoptosis by Vitamin D3 and quercetin are analyzed and probable mechanism of action is elaborated. This study thus opens up newer avenues in tackling keloid scars effectively.

Les cicatrices chéloïdes restent un défi pour les cliniciens car il n'existe pas encore un agent efficace pour les traiter. Pour cette raison nous avons entrepris une étude in vitro sur le mécanisme d'action de la vitamine D3 et la quercétine sur des fibroblastes isolées à partir de chéloïdes. Nous avons analysé l'effet dose dépendant de la vitamine D3 et la quercétine sur la diminution de la prolifération cellulaire, la synthèse du collagène et de l'induction de l'apoptose, et élaboré le mécanisme probable de cette action. Notre étude ouvre ainsi des voies nouvelles dans la lutte contre les cicatrices chéloïdes.