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Objective To assess treatment outcomes in tuberculosis patients participating in support group meetings in five districts of Karnataka and Telangana states in southern India. Methods Tuberculosis patients from five selected districts who began treatment in 2019 were offered regular monthly support group meetings, with a focus on patients in urban slum areas with risk factors for adverse outcomes. We tracked the patients' participation in these meetings and extracted treatment outcomes from the Nikshay national tuberculosis database for the same patients in 2021. We compared treatment outcomes based on attendance of the support groups meetings. Findings Of 30 706 tuberculosis patients who started treatment in 2019, 3651 (11.9%) attended support groups meetings. Of patients who attended at least one support meeting, 94.1% (3426/3639) had successful treatment outcomes versus 88.2% (23 745/26 922) of patients who did not attend meetings (adjusted odds ratio, aOR: 2.44; 95% confidence interval, CI: 2.10-2.82). The odds of successful treatment outcomes were higher in meeting participants than non-participants for all variables examined including: age [greater than or equal to] 60 years (aOR: 3.19; 95% CI: 2.26-4.51); female sex (aOR: 3.33; 95% CI: 2.46-4.50); diabetes comorbidity (aOR: 3.03; 95% CI: 1.91-4.81); human immunodeficiency virus infection (aOR: 3.73; 95% CI: 1.76-7.93); tuberculosis retreatment (aOR: 1.69; 1.22-2.33); and drug- resistant tuberculosis (aOR: 1.93; 95% CI: 1.21-3.09). Conclusion Participation in support groups for tuberculosis patients was significantly associated with successful tuberculosis treatment outcomes, especially among high-risk groups. Expanding access to support groups could improve tuberculosis treatment outcomes at the population level. Objectif Evaluer les resultats des traitements contre la tuberculose chez les patients qui assistent aux reunions des groupes d'entraide dans cinq districts des Etats du Karnataka et du Telangana, en Inde du Sud. Methodes Dans les cinq districts selectionnes, des patients tuberculeux ayant entame un traitement en 2019 se sont vu proposer des reunions mensuelles organisees a intervalles reguliers. Ces reunions etaient principalement destinees aux patients vivant dans des bidonvilles urbains et presentant des facteurs augmentant le risque d'issue defavorable. Nous avons suivi leur participation aux reunions et avons extrait des informations therapeutiques de la base de donnees nationale Nikshay sur la tuberculose concernant les memes patients en 2021. Nous avons ensuite compare l'issue des traitements a la presence aux reunions des groupes d'entraide. Resultats Sur 30 706 patients tuberculeux ayant entame un traitement en 2019, 3651 (11,9%) ont rejoi nt des groupes d'entraide. Sur l'ensemble des patients ayant assiste a au moins une reunion, 94,1% (3426/3639) ont connu une issue favorable au traitement, contre 88,2% (23 745/26 922) chez les patients qui n'y ont pas assiste (odds ratio ajuste, ORA: 2,44; intervalle de confiance de 95%, IC: 2,10-2,82). Les probabilites de reussite du traitement etaient plus elevees chez les participants aux reunions que chez les non-participants pour toutes les variables examinees, y compris pour les [greater than or equal to] 60 ans (ORA: 3,19; IC de 95%: 2,26-4,51); les patients de sexe feminin (ORA: 3,33; IC de 95%: 2,46-4,50); celles et ceux presentant une comorbidite liee au diabete (ORA: 3,03; IC de 95%: 1,91-4,81); une infection au virus de l'immunodeficience humaine (ORA: 3,73; IC de 95%: 1,76-7,93); un retraitement contre la tuberculose (ORA: 1,69; 1,22-2,33); et enfin, une tuberculose pharmacoresistante (ORA: 1,93; IC de 95%: 1,21-3,09). Conclusion La participation des patients atteints de tuberculose aux groupes d'entraide allait de pair avec de meilleurs resultats de traitement, surtout au sein des categories a haut risque. Promouvoir l'acces a ces groupes d'entraide pourrait ameliorer l'issue des traitements contre la tuberculose a l'echelle de la population. Objetivo Evaluar los desenlaces del tratamiento en pacientes con tuberculosis que participan en reuniones de grupos de apoyo en cinco distritos de los estados de Karnataka y Telangana en el sur de la India. Metodos Se ofrecieron reuniones mensuales regulares de grupos de apoyo a los pacientes con tuberculosis de cinco distritos seleccionados que comenzaron el tratamiento en 2019, con un enfoque en los pacientes de los suburbios urbanos con factores de riesgo de desenlaces adversos. Se realizo un seguimiento de la participacion de los pacientes en estas reuniones y se extrajeron los desenlaces del tratamiento de la base de datos nacional de tuberculosis Nikshay para los mismos pacientes en 2021. Se compararon los desenlaces del tratamiento en funcion de la asistencia a las reuniones de los grupos de apoyo. Resultados De 30 706 pacientes con tuberculosis que iniciaron el tratamiento en 2019, 3651 (11,9 %) asistieron a reuniones de grupos de apoyo. De los pacientes que asistieron al menos a una reunion de apoyo, el 94,1 % (3426/3639) presentaron desenlaces exitosos del tratamiento frente al 88,2 % (23 745/26 922) de los pacientes que no asistieron a las reuniones (razon de posibilidades ajustada, RPA: 2,44; intervalo de confianza del 95 %, IC: 2,10-2,82). Las posibilidades de obtener un desenlace satisfactorio del tratamiento fueron mayores en los participantes en las reuniones que en los no participantes para todas las variables examinadas, incluyendo: edad [greater than or equal to] 60 anos (RPA: 3,19; IC del 95 %: 2,26-4,51); sexo femenino (RPA: 3,33; IC del 95 %: 2,46-4,50); comorbilidad por diabetes (RPA: 3,03; IC del 95 %: 1,91-4,81); infeccion por el virus de la inmunodeficiencia humana (RPA: 3,73; IC del 95 %: 1,76-7,93); retratamiento de la tuberculosis (RPA: 1,69; IC del 95 %: 1,22-2,33); y tuberculosis resistente (RPA: 1,93; IC del 95 %: 1,21-3,09). Conclusion La participacion en grupos de apoyo para pacientes con tuberculosis se asocio de manera significativa con el exito de los desenlaces del tratamiento de la tuberculosis, en especial entre los grupos de alto riesgo. Ampliar el acceso a los grupos de apoyo podria mejorar los desenlaces del tratamiento de la tuberculosis a nivel de la poblacion., Introduction Estimates indicate that India has the largest number of tuberculosis patients (26%) and tuberculosis-related deaths (36%) in the world. (1) India's success in tackling tuberculosis is critical to achieving [...]

Byline: Amar. Shah, Anirudh. Shah Intraperitoneal bladder rupture is a rare event in the paediatric population. Road traffic accidents (RTA) and seat belt injuries are considered to be the main [...]

BACKGROUND. Sex, emotion, and reproduction are fundamental and tightly entwined aspects of human behavior. At a population level in humans, both the desire for sexual stimulation and the desire to bond with a partner are important precursors to reproduction. However, the relationships between these processes are incompletely understood. The limbic brain system has key roles in sexual and emotional behaviors, and is a likely candidate system for the integration of behavior with the hormonal reproductive axis. We investigated the effects of kisspeptin, a recently identified key reproductive hormone, on limbic brain activity and behavior. METHODS. Using a combination of functional neuroimaging and hormonal and psychometric analyses, we compared the effects of kisspeptin versus vehicle administration in 29 healthy heterosexual young men. RESULTS. We demonstrated that kisspeptin administration enhanced limbic brain activity specifically in response to sexual and couple-bonding stimuli. Furthermore, kisspeptin's enhancement of limbic brain structures correlated with psychometric measures of reward, drive, mood, and sexual aversion, providing functional significance. In addition, kisspeptin administration attenuated negative mood. CONCLUSIONS. Collectively, our data provide evidence of an undescribed role for kisspeptin in integrating sexual and emotional brain processing with reproduction in humans. These results have important implications for our understanding of reproductive biology and are highly relevant to the current pharmacological development of kisspeptin as a potential therapeutic agent for patients with common disorders of reproductive function. FUNDING. National Institute for Health Research (NIHR), Wellcome Trust (Ref 080268), and the Medical Research Council (MRC)., Introduction Unraveling the intrinsic links among sex, emotion, and reproduction relies on a focused exploration of putative factors. Identifying a factor that unites these fundamental components of human behavior has [...]

Background : Sex cord and stromal tumors are a heterogeneous group of tumors that arise from gonadal sex cord cells, gonadal stromal cells, or both. They are divided into pure stromal tumors, pure sex cord tumors, and mixed tumors. Some of these tumors are hormonally active, producing androgens and estrogens, and may therefore exhibit virilization or excess estrogen. Sertoli-Leydig cell tumors are rare tumors belonging to mixed tumors representing less than 0.5% of ovarian tumors. Few cases have been reported in the medical literature. Case presentation: We report the case of a 1-year-old girl who was admitted for breast lumps and pubic hair with intermittent painless vaginal bleeding in the past 2 weeks. The abdominal examination objectified the presence of an intraperitoneal mass to which an abdominal ultrasound and computerized tomography (CT) scan had confirmed the presence of a right ovarian mass. A laparoscopy was performed which showed an encapsulated mass arriving from the right ovary replacing the normal ovarian tissue. Laparoscopic-assisted removal of the entire mass was done. The postoperative course was uneventful. The histopathological study demonstrated an intermediately differentiated Sertoli cell tumor with an intact capsule, no lymphovascular invasion, or heterologous elements (TNM stage 1). Conclusions: Although Sertoli-Leydig tumors are commonly seen after the second decade of life in young women, their discovery before puberty is not uncommon. Mass syndrome and signs of virilization are two frequently reported signs that should prompt the clinician to mention this entity among the differential diagnoses. The first-line radiological examination is pelvic ultrasound. The treatment is mainly based on surgery. The prognosis is excellent especially if the tumor is well differentiated. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive pediatric surgery has gained popularity over open conventional surgery as it offers benefits to both patients and health care practitioners. Creation of pneumoperitoneum is a must for any laparoscopic procedure. Different pediatric surgeons have their individual preferences regarding the technique to create pneumoperitoneum prior to laparoscopy. The aim of this study was to evaluate the preference of technique for the creation of pneumoperitoneum in pediatric laparoscopy among Indian Pediatric Surgeons. The study was designed by communication with members of the Indian Association of Pediatric Surgeons using a predefined questionnaire. 180 pediatric surgeons responded to the survey. The respondents included pediatric surgeons in institutional and private practice. The reasons behind their preference were enumerated and evaluated. Results: Seventy-one percent of pediatric surgeons preferred the primary open technique for the creation of pneumoperitoneum. Seventeen percent exclusively used Veress needle whereas 12% were using both techniques varying from patient to patient. Conclusion: Creation of pneumoperitoneum remains an important safety issue for all pediatric surgeons. Pediatric Surgeons in India prefer using the primary open technique for the creation of pneumoperitoneum for laparoscopic surgery. [ABSTRACT FROM AUTHOR]

Background: Hamartoma is a benign, tumor-like proliferation of mature tissue that is natural to the organ from which it developed. Oral hamartomas are rare and can occur as an isolated finding or as a part of a syndrome. Case presentation: We report a 4-day-old male neonate who was postnatally noted to have a large 3.5 × 3.5 cm lobulated mass over the tip of the tongue. The mass was causing protrusion of the tongue and feeding difficulties following which surgical excision was planned. The postoperative recovery was uneventful. Conclusion: Although rare, lingual hamartomas should be considered in the differential diagnosis algorithm for congenital tongue lesions. The definitive diagnosis is histopathological with complete resection of the tumor resulting in a favorable prognosis. [ABSTRACT FROM AUTHOR]

Background: Congenital granular cell tumor (CGCT) is a rare benign soft tissue tumor of the new born. It is also called congenital epulis. Case presentation: We report the case of a 3-day-old male neonate who was postnatally noted to have a 2-cm mass over the maxillary alveolar ridge in the midline. The mass was causing feeding difficulties, and hence, decision for surgical excision was taken. The postoperative recovery was uneventful. Conclusion: Congenital granular cell tumor (CGCT) is commonly seen on the gingival margins of the maxilla or mandible. Large tumors may cause polyhydramnios in the antenatal period or feeding and respiratory difficulties in the postnatal period. Diagnosis is usually confirmed by histopathology. Malignant change or recurrence has not been reported following incomplete excision of this mass. [ABSTRACT FROM AUTHOR]

Background: Effects of pulse pressure and benefits of blood pressure lowering with intravenous anti-hypertensive medications and beta-blockers in CVA patients have not been well investigated.Material and Methods: Demographic, clinical, and echocardiographic data were collected and long-term outcomes (55+/-21 months) were ascertained in 356 consecutive cerebro-vascular accident (CVA) patients. ANOVA, chi-square, Kaplan-Meier, and logistic regression tests were employed. Study was approved by the institutional IRB.Results: Widened pulse pressure on admission was significantly elevated in CVA patients who expired in the hospital or during the long-term follow-up (62+/-21mmHg for long-term survivors vs. 72+/-20mmHg for hospital deaths vs. 69+/-28 mmHg for long-term deaths, p=0.01). There was a trend towards increased hospital mortality (14% in long-term survivors vs. 25% in hospital deaths vs. 22% in long-term deaths, p=0.110) in CVA patients requiring IV anti-hypertensive therapy. Utilization of beta-blockers was lower in patients who suffered hospital death, but more likely in patients experiencing long-term death (42% use in hospital deaths vs. 48% in long-term survivors vs. vs. 66% in long-term deaths, p=0.003). Beta-blocker use was not predictive of hospital outcomes but was strongly predictive of adverse event long-term events (HR 2.1, 95%CI 1.3-3.4, p=0.002). When adjusted for demographic parameters and co-morbidities in multivariate analysis, pulse pressure and IV anti-hypertensive therapy were not predictive of short or long-term outcomes, while beta-blocker treatment was associated with reduced hospital (0.3, 95%CI 0.1-0.9, p=0.029) but not long-term mortality.Conclusions: Widened pulse pressure and need for IV anti-hypertensive therapy are not predictive of adverse short- or long-term outcomes when demographics and co-morbidities are accounted for. Effects of beta-blocker therapy on outcomes in CVA patients are complex. Wider beta-blocker use in acute CVA may be associated with better hospital outcomes, while increased long term mortality with beta-blocker therapy may be indicative of poor cardiovascular health leading to adverse outcomes [ABSTRACT FROM AUTHOR]