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Background: Anaemia is the most common disease that affects mostly females and children and is most prevalent in developing countries. Among various causes sickle cell anaemia is one of them, which is a cause of concern. Sickle Cell Disease (SCD) causes problems like blockage of blood flow, causing pain, and fatigue and also leads to death. Objective: With the advancement in science, diseases that were once considered unable to cure can be stopped or prevented and, in some cases, also be cured. As current therapies for the treatment of sickle cell anaemia are limited, like blood transfusions, bone marrow transfusions, etc., a non-surgical method where plant extracts or compounds were found effective in stopping, preventing, and in some cases reversal of SCD. In this review, we tried to gather information about those plants and compounds. Method: Numerous surveys in the literature were performed to determine the plants which have shown their potential against SCD. Relevant peer-reviewed publications were searched through various databases such as ScienceDirect, PubMed, Google Scholar, Research Gate, etc. Results: A total of more than 50 medicinal plants such as Acacia catechu, Alchornea cordifolia, Anchomanes difformis, Khayase negalensis, Terminalia catappa, etc., have been identified based on their potential against SCD, and 15 compounds such as Butylurea, Glyceraldehyde, Potassium cyanate, urea, etc., have also been identified which could work against SCD. These plants acting on sickle cell anemia on various pathways are also discussed. Conclusion: In this review, an approach was made to study those plants which have an effect against SCD, with proper mechanisms and compounds that show potency against this disease. So that better treatment options could be available for future generations.

To compare breast milk volume between manual method and breast pump expression in mothers of preterm infants at different time point of first week.Randomized controlled trial.Postpartum ward of Obstetrics department and tertiary level neonatal intensive care unit (NICU) in a single institution in Orissa between October, 2020 and May, 2021.Mothers who delivered before 34 completed weeks of gestation.Manual breastmilk expression (ME) group using Marmet technique and breast pump milk expression (PE) group using pigeon manual breast pump, initiated milk expression within one hour of delivery.Expressed breast milk (EBM) volume in mothers of preterm infants at different time point of first week, and cumulative milk volume.Out of 170 mothers (83 PE and 87 ME group), 7-days milk volume data was available for 137 (71 ME and 66 PE) mothers. In per protocol analysis for 126 mothers (63 in each group), the median (IQR) EBM volume on day 2 and day 7 of ME and PE groups were similar [10 (5,20) vs 12 (5,28), P=0.10] and [280 (220-356) vs 280 (220-360), P=0.66]. The median (IQR) cumulative EBM volume over first 7 days in ME group was not significantly different from PE group [733 (593-995) vs 848.5 (571-1009)] P=0.55). A similar number of mothers in the PE and ME group [56 (88.9%) vs 58 (92%); P=0.14] provided exclusive breast milk for their neonates during the first week. Similar results were found on intention to treat analysis.EBM volume expressed was comparable between mothers expressing manually or with breast pump.

Abstract: Nuclear factor-kappa B (NF-κB) is one of the principal inducible proteins and a predominant transcription factor that is known to control gene expression in mammals. It plays a pivotal role in regulating cell signalling in the body under certain physiological and pathological conditions. In cancer cells, such as colon, breast, pancreatic, ovarian, melanoma, and lymphoma, the NF-κB pathway is active. In cellular proliferation, promoting angiogenesis, invasion, metastasis of tumour cells, and blocking apoptosis, the constitutive activity of NF-κB signalling has been reported. Therefore, immense attention has been given to developing drugs targeting NF-κB signalling pathways to treat many types of tumours. They are a desirable therapeutic target for drugs, and many studies have concentrated on recognizing compounds. They may be able to reverse or standstill the growth and spread of tumours that selectively interfere with this pathway. Recently, numerous substances derived from plants have been evaluated as possible inhibitors of the NF-κB pathway. These include various compounds, such as flavonoids, lignans, diterpenes, sesquiterpenes, polyphenols, etc. A study supported by folk medicine demonstrated that plant-derived compounds could suppress NF-κB signalling. Considering this, the present review revealed the anticancer potential of naturally occurring compounds that inhibit the NF-κB signalling and suppress the growth and spread of cancer.

Objective- To evaluate the clinical characteristics of hypoglycemic brain injury (HBI) in unanticipated term neonates, confirmed by neuroimaging. Methodology- We reviewed Magnetic resonance imaging (MRI) of brain of term neonatal encephalopathy cases, from January 2018 to November 2020. Neonates with MRI topography suggestive HBI and documented hypoglycemia from case records were enrolled in study. Perinatal data, clinical characteristics and management of cases was recorded. Descriptive statistics was used to analyse the data. Result-Total 13 term neonates had brain MRI suggestive of HBI conducted at median postnatal age of 7 days. The mean birth weight of HBI neonates was 2582 ± 285 gram, mean gestational age 38.15± 0.48 weeks and five (38.4%) babies were low birth weight. Eight (61.5%) babies were delivered by caesarean section, eleven (84.6%) were first born, twelve (92.3%) were male and nine (69.2%) were on exclusive breastfeeding. Out of thirteen neonates twelve (92.3%) were outborn, mean age of symptom noticed was 2.83±0.53 days and mean age of admission was 3.84± 0.82 days. Mean blood glucose at admission was 28.84±3.23 mg/dl and four (30.7%) were diagnosed with hypoglycemia at referral hospital.

Abstract: About 50.8 million people were diagnosed with diabetes in 2011; the count has increased by 10 million in the last five years. Type-1 diabetes could occur at any age, but predominantly in children and young adults. The risk of developing type II diabetes mellitus in the offspring of parents with DM II is 40% if one parent has DM II and approaches 70% if both parents have DM II. The process of developing diabetes from normal glucose tolerance is continuous, with insulin resistance being the first stage. As prediabetes progresses slowly to DM II, it may take approximately 15–20 years for an individual to become diabetic. This progression can be prevented or delayed by taking some precautions and making some lifestyle amendments, e.g., reducing weight by 5–7% of total body weight if obese, etc. Retinoblastoma protein is one of the pocket proteins that act as crucial gatekeepers during the G1/S transition in the cell cycle. A loss or defect in single-cell cycle activators (especially CDK4 and CDK6) leads to cell failure. In diabetic or stress conditions, p53 becomes a transcription factor, resulting in the transactivation of CKIs, which leads to cell cycle arrest, cell senescence, or cell apoptosis. Vitamin D affects insulin sensitivity by increasing insulin receptors or the sensitivity of insulin receptors to insulin. It also affects peroxisome proliferator-activated receptors (PPAR) and extracellular calcium. These influence both insulin resistance and secretion mechanisms, undertaking the pathogenesis of type II diabetes. Conclusion:: The study confines a marked decrement in the levels of random and fasting blood glucose levels upon regular vitamin D intake, along with a significant elevation of retinoblastoma protein levels in the circulatory system. The most critical risk factor for the occurrence of the condition came out to be family history, showing that patients with first-degree relatives with diabetes are more susceptible. Factors such as physical inactivity or comorbid conditions further aggravate the risk of developing the disease. The increase in pRB levels caused by vitamin D therapy in prediabetic patients directly influences blood glucose levels. pRB is supposed to play a role in maintaining blood sugar levels. The results of this study could be used for further studies to evaluate the role of vitamin D and pRB in regeneration therapy for beta cells in prediabetics.

Abstract: Due to its extensive applications in the field of pharmaceutical chemistry and its potent biological and pharmacological activities, including analgesic, antioxidant, antimicrobial, anticancer, ant-inflammatory, anti-tubercular, antihyperlipidemic, antihistamine, antiviral, anticonvulsant and antiparkinsonian, the heterocyclic molecule occupies a distinct place in the scientific community. The discovery that many synthetic quinazolinone derivatives exhibit a wide range of biological functions has sparked interest in this area of study. The purpose of this review is to collate literature work reported by researchers on quinazolinone and its derivatives for their various pharmacological activities.

Introduction: To obtain the binding site of a model of the human 5-HT1A/2A receptor, a series of substituted 2,4-imidazolidinediones and oxazolidinediones were subjected to flexible docking using GLIDE. Methods: The docking scores that were generated are correlated with the in-vivo affinity data that had already been collected. Results: When combined with a homology model of 5HT1A/2A, the GLIDE docking approach was based on a template for 2-adrenergic receptors. Conclusion: A model for ligand binding in the hydrophobic portion of the binding site was proposed after discussing the impact of the structure and hydrophobic characteristics of the aryl moiety on binding affinities.

Preterm neonates perceive multiple painful procedures during Neonatal Intensive Care Unit (NICU) stay, having long term neurobehavioral effects. This study aims to compare the analgesic efficacy of oral melatonin with 24% sucrose in neonates during retinopathy of prematurity (ROP) screening.A prospective, non-blinded, randomized controlled trial was conducted in a tertiary care NICU. All preterm neonates with gestational age (GA)34 weeks or birth weight (BW)2000 grams eligible for ROP screening were randomized into oral melatonin (4 mg/kg) and oral 24% sucrose (0.5 ml) groups. Both groups received standard non-pharmacological measures and topical proparacaine. The intensity of pain was measured by Premature Infant Pain Profile (PIPP) score during the procedure, at 1st and 5th minutes following the procedure and compared between the two groups by Mann-Whitney U test with p value0.05 considered as significant.A total of 60 preterm neonates were randomized with 30 neonates in the melatonin (median [interquartile range] GA: 30.86 [3.78] weeks, BW: 1160 [430] grams) and 30 neonates in the 24% sucrose (median [IQR] GA: 29.29 [4.68] weeks, BW: 1070 [315] grams) group. The median PIPP score during the procedure in the melatonin and sucrose groups were 17 and 16, respectively (p=0.64). The median (Q1-Q3) PIPP score at the 1st minute was significantly lower among the melatonin group (7 [5.25-10]) vs 24% sucrose group (9.5 [7.25-11]) (p=0.02); and at the 5th minute, the median (Q1-Q3) PIPP scores in the melatonin group (5 [4-6]) was comparable to the 24% sucrose group (5.5 [3.25-7]) (p= 0.52).Oral melatonin is not inferior to oral 24% sucrose for pain management during ROP screening.

A prerequisite for nerve-sparing pelvic surgery is a thorough understanding of the topographic anatomy of the fine and intricate pelvic nerve networks, and their connections to the central nervous system. Insights into the functions of pelvic nerves will help to interpret disease symptoms correctly and improve treatment. In this article, we review the anatomy and physiology of autonomic pelvic nerves, including their topography and putative functions. The aim is to achieve a better understanding of the mechanisms of pelvic pain and functional disorders, as well as improve their diagnosis and treatment. The information will also serve as a basis for counseling patients with chronic illnesses. A profound understanding of pelvic neuroanatomy will permit complex surgery in the pelvis without relevant nerve injury.

A flexible docking of a series of heteroaryl compounds to the binding site of a model of human 5-HT1A/2A receptor was exercised using GLIDE docking methods. The resultant docking scores were used to correlate the in vivo affinity data. The GLIDE docking algorithm when used with a homology model of 5HT1A/2A was based on β2- adrenergic receptor template. The influence of structure and hydrophobic properties of aryl moiety on binding affinities was discussed and a model for ligand binding in the hydrophobic part of the binding site was proposed.

Background Parkinson’s disease (PD) is associated with motor and behavioral dysfunctions. Mitochondrial damage, increased oxidative stress, and the formation of Lewy bodies by misfolded proteins are major pathways for the development of PD. Using antioxidants could delay neurodegeneration in parkinsonism and improve the symptoms. We investigated the neuroprotective effects of quercetin, curcumin, and their combination on the rotenone-induced parkinsonism model. Methods PDwas induced by administration of rotenone 2mg/kg/day for 14 days in rats. Curcumin (100, 150, and 200 mg/kg), quercetin (30, 40, and 50 mg/kg),or their combination were given orally for 14 days concurrently with rotenone and for additional 14 days. On the 28th and 29th days, behavioral and histological studies were carried out. Results In the rotenone-induced parkinsonism model, curcumin and quercetin dose-dependently improved locomotor activity, motor coordination, and mobility. Also, they increased dopamine levels and mitigated the neural damage induced by rotenone. Conclusion Both curcumin and quercetin have neuroprotective effects against parkinsonism. The combination of curcumin and quercetin has more favorable effects than usingeither drug alone.

Curcumin, a natural polyphenol from Curcuma longa, is known to possess diversified pharmacological roles including anti-inflammatory, antioxidant, antiproliferative and antiangiogenic properties; however, its bioavailability is severely limited due to its poor solubility, poor absorption, rapid metabolism, and significant elimination. Hydrazinocurcumin (HZC), a novel analogue of curcumin has been reported to overcome the limitations of curcumin and also possesses multiple pharmacological activities. The present study aimed to evaluate the unexplored pharmacokinetic profile of this agent in experimental rats. Drug formulations were administered to the experimental animals via oral, intravenous and intraperitoneal routes. Blood samples were collected at different pre-determined time intervals to determine the pharmacokinetic parameters. To understand the biodistribution profile of HCZ, tissue samples were isolated from different groups of Sprague–Dawley rats at different time points. The pharmacokinetic parameters of HZC were evaluated after administration through oral (100 mg/kg), intraperitoneal (100 mg/kg) and intravenous (10 mg/kg) routes. Significantly (p

Background Fibroids of the uterus are the most common benign pelvic tumors in women worldwide. Their diagnosis is usually not missed because of the widespread and well-established use of ultrasound in gynecological clinics. Hence, the development of an unusually large myoma is a rare event, particularly in first-world countries such as Germany. It is even more uncommon that a myoma is misdiagnosed as a dietary failure. Case presentation Herein, we report the case of a Caucasian woman with a giant fibroid that reached a size of over 50 cm, growing slowly over the past 15 years, and was misdiagnosed as abdominal fat due to weight gain. We aim to discuss the factors that lead to the growth of such a huge tumoral mass, including misdiagnosis and treatment, and the psychological impact. Through this case, we intend to increase the awareness among general physicians and gynecologists. Although menstrual disorders incorporate several pathologies, adequate assessment remains the primary responsibility of health care providers. A literature review revealed approximately 60 cases of giant uterine fibroids. Conclusion The use of clinical and diagnostic devices, especially ultrasound, in this case, is indispensable. In conclusion, the growth of a giant fibroid can have disastrous effects on a woman’s health, including surgical trauma and psychological issues.

Background: Cancer is one of the major causes of human mortality worldwide. A number of existing antineoplastic medications and treatment regimens are already working in the field, and several new compounds are in different phases of clinical trials. An extensive series of anticancer drugs exist in the market, and studies suggest that these molecules are associated with different types of adverse side effects. The reduction of the cytotoxicity of drugs to normal cells is a major problem in anticancer therapy. : Therefore, researchers around the globe are involved in the development of more efficient and safer anticancer drugs. The output of extensive research is that the quinazoline scaffold and its various derivatives can be explored further as a novel class of cancer chemotherapeutic agents that has already shown promising activities against different tumours. Quinazoline derivatives have already occupied a crucial place in modern medicinal chemistry. Various research has been performed on quinazoline and their derivatives for anticancer activity and pharmacological importance of this scaffold has been well established. Objective: The aim of this review is to compile and highlight the developments concerning the anticancer activity of quinazoline derivatives as well as to suggest some new aspects of the expansion of anticancer activity of novel quinazoline derivatives as anticancer agents in the near future. Methods: Recent literature related to quinazoline derivatives endowed with encouraging anticancer potential is reviewed. With a special focus on quinazoline moiety, this review offers a detailed account of multiple mechanisms of action of various quinazoline derivatives: inhibition of the DNA repair enzyme system, inhibition of EGFR, thymidylate enzyme inhibition and inhibitory effects for tubulin polymerization by which these derivatives have shown promising anticancer potential. Results: Exhaustive literature survey indicated that quinazoline derivatives are associated with properties of inhibiting EGFR and thymidylate enzymes. It was also found to be involved in disturbing tubulin assembly. Furthermore, quinazoline derivatives have been found to inhibit critical targets such as DNA repair enzymes. These derivatives have shown significant activity against cancer. Conclusion: In cancer therapy, Quinazoline derivatives seems to be quite promising and act through various mechanisms that are well established. This review has shown that quinazoline derivatives can further be explored for the betterment of chemotherapy. A lot of potentials are still hidden, which demands to be discovered for upgrading quinazoline derivatives efficacy.

A novel virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), appeared and expanded globally by the end of the year 2019 from Wuhan, China, causing the severe acute respiratory syndrome. During its initial stage, the disease was called the novel coronavirus (2019-nCoV). It was named COVID-19 by the World Health Organization (WHO) on 11th February, 2020. The WHO declared the SARS-CoV-2 virus a pandemic in March 2020. On 30th January, 2020, the first case of Corona Virus Disease 2019 (COVID-19) was reported in India. Currently, the virus has spread to almost every part of the province and the rest of the globe. : On the basis of novel published evidence, we efficiently summarized the reported work with reference to COVID-19 epidemiology, pathogen, clinical symptoms, treatment, and prevention. Several worldwide electronic scientific databases such as Pubmed, Medline, Embase, Science Direct, Scopus, etc., were utilized for extensive investigation of relevant literature. : This review is written in the hope of encouraging people with the key learning points from the underway efforts to perceive and manage SARS-CoV-2, suggesting salient points for expanding future research.

Attachment to and fusion with cell membranes are two major steps in the replication cycle of many human viruses. We focus on these steps for three enveloped viruses, i.e., HIV-1, IAVs, and SARS-CoV-2. Viral spike proteins drive the membrane attachment and fusion of these viruses. Dynamic interactions between the spike proteins and membrane receptors trigger their specific attachment to the plasma membrane of host cells. A single virion on cell membranes can engage in binding with multiple receptors of the same or different types. Such dynamic and multivalent binding of these viruses result in an optimal attachment strength which in turn leads to their cellular entry and membrane fusion. The latter process is driven by conformational changes of the spike proteins which are also class I fusion proteins, providing the energetics of membrane tethering, bending, and fusion. These viruses exploit cellular and membrane factors in regulating the conformation changes and membrane processes. Herein, we describe the major structural and functional features of spike proteins of the enveloped viruses including highlights on their structural dynamics. The review delves into some of the case studies in the literature discussing the findings on multivalent binding, membrane hemifusion, and fusion of these viruses. The focus is on applications of biophysical tools with an emphasis on single-particle methods for evaluating mechanisms of these processes at the molecular and cellular levels.

A variety of procedures have been used for family planning. One of these is sterilization surgery, which can be reversed by a tubal reanastomosis. In the present report, we compare Robot-assisted tubal reanastomosis sterilization with other methods of family planning and discuss factors related to the choice of the approach. The keywords used for the electronic search in PubMed were family planning, sterilization, Robot-assisted, tubal reanastomosis, depression, and regret. The decision in favor of or against sterilization surgery has been a sensitive issue for several years. Robot-assisted technology is a modern and precise approach. It has contributed to the flexibility of the decision between sterilization and its reversal through tubal reanastomosis, as well as enhanced the success rate of the surgery. Based on our analysis of the published literature, we believe that Robot-assisted tubal anastomosis is the optimum approach. However, to ensure the quality of health care, the surgeon must be well trained, well versed with the anatomy of the fallopian tubes, and thoroughly informed on the psychological impact of family planning.

TB is becoming a worldwide problem and it was declared since 1993 by the World Health Organization (WHO), a global health emergency. The current problem of tuberculosis therapy is the emergence of multi-drug resistant (MDR) strains, caused by the improper use of antibiotics in chemotherapy of TB patients. Azatidinones, a β-lactam cyclic amide with four atoms in a ring, has been considered as a magic moiety (wonder nucleus) which possesses almost all types of biological activities. This diversity in the biological response profile has attracted the attention of many researchers to explore this skeleton to its multiple potential against several activities. Present article is sincere attempt to review chemistry, method of synthesis of azatidinones and to study azatidinones synthesized in last few years which have shown potent antitubercular activity.

The objective of this study was to explore the availability of expressed breast milk (EBM) volume for the premature neonates born from mothers in different gestational age groups during neonatal intensive care unit (NICU) stay. All preterm infants (extreme-preterm infant [EPTI

Alzheimer’s disease (AD) is a multifarious and developing neurodegenerative disorder. The treatment of AD is still a challenge and availability of drug therapy on the basis of symptoms is not up to the mark. In the context of existence, which is getting worse for the human brain, it is necessary to take care of all critical measures. The disease is caused due to multidirectional pathology of the body, which demands the multi-target-directed ligand (MTDL) approach. This gives hope for new drugs for AD, summarized here in with the pyrimidine based natural product inspired molecule as a lead. The review is sufficient in providing a list of chemical ingredients of the plant to cure AD and screen them against various potential targets of AD. The synthesis of a highly functionalized scaffold in one step in a single pot without isolating the intermediate is a challenging task. In few examples, we have highlighted the importance of this kind of reaction, generally known as multi-component reaction. Multi-component is a widely accepted technique by the drug discovery people due to its high atom economy. It reduces multi-step process to a one-step process, therefore the compounds library can be made in minimum time and cost. This review has highlighted the importance of multicomponent reactions by giving the example of active scaffolds of pyrimidine/fused pyrimidines. This would bring importance to the fast as well as smart synthesis of bio-relevant molecules.

Older patients with cancer are more vulnerable to the effects of cognitive impairment affecting their functional status, quality of life, compliance to treatment and ultimately survival. Cancer-related cognitive impairment may be due to the cancer itself or due to the treatment of cancer. There are no data regarding the prevalence of cognitive impairment in older persons with cancer and brain metastasis.This retrospective analysis was conducted on a prospectively collected data set of patients who attended the geriatric oncology clinic at a tertiary care comprehensive cancer centre in India from June 2018 to July 2021. Patients aged 60 years and above with malignancy were included. Cognition was assessed with the mini-mental status examination (MMSE); the Hindi MMSE was used for illiterate patients. A score of ≤23 on the MMSE was considered abnormal. Correlation between the presence of cognitive impairment and brain metastasis was tested using the chi-square test.A total of 597 patients were included, of which 462 (77.4%) were male. The median age was 69 years (range: 60-100 years). All patients had solid tumours; 244 (40.9%) had lung, 189 (31.7%) had gastrointestinal and 75 (12.6%) had head and neck malignancies. Forty-one (6.9%) patients had brain metastases, of which 10 (24.4%) had solitary, 30 (73.2%) had multiple lesions and 1 (2.4%) had leptomeningeal metastases. Cognitive impairment was noted in 11 (26.8%) of the 41 patients with brain metastases and 91 (16.4%) of the 556 patients without brain metastases. There was no significant correlation between the presence of brain metastases and cognitive impairment,Older persons with cancer and brain metastases were not found to have a higher occurrence of cognitive impairment than those without brain metastases in this study. The next step is to understand whether older persons with brain metastases are at a higher risk for cognitive decline as a result of therapeutic interventions such as cranial radiotherapy and chemotherapy.

A vast advancement has been made in the treatment related to central nervous system disorders especially Parkinson’s disease. The development in therapeutics and a better understanding of the targets results in upsurge of many promising therapies for Parkinson’s disease. Parkinson’s disease is defined by neuronal degeneration and neuroinflammation and it is reported that the presence of the neurofibrillary aggregates such as Lewy bodies is considered as the marker. Along with this, it is also characterized by the presence of motor and non-motor symptoms, as seen in Parkinsonian patients. A lot of treatment options mainly focus on prophylactic measures or the symptomatic treatment of Parkinson’s disease. : Neuroinflammation and neurodegeneration are the point of interest which can be exploited as a new target to emphasis on Parkinson’s disease. : A thorough study of these targets helps in modifications of those molecules which are particularly involved in causing the neuronal degeneration and neuroinflammation in Parkinson’s disease. : A lot of drug regimens are available for the treatment of Parkinson’s disease, although levodopa remains the choice of drug for controlling the symptoms, yet is accompanied with significant snags. It is always suggested to use other drug therapies concomitantly with levodopa. : A number of significant causes and therapeutic targets for Parkinson’s disease have been identified in the last decade, here an attempt was made to highlight the most significant of them. It was also found that the treatment regimen and involvement of therapies are totally dependent on individuals and can be tailored to the needs of each individual patient.

The pectoralis major flap is undoubtedly a workhorse flap in the field of head and neck oncology even with the advent of free flaps. Lack of expertise and resources limits the use of free flap and still makes pectoralis major flap widely chosen. Head and neck cancer in advanced stage requires extensive resection entailing reconstruction of various sized defects which is possible only with a versatile flap. This flap is also a salvage flap when all the other options failed, since four decades. The purpose of this article is to highlight variations and modifications related to pectoralis major flap in head and neck reconstructive procedures. For this a thorough literature search was done using Medline and PubMed databases. Non-English language papers were excluded from the review. A total of 50 articles were obtained through verification of the title and abstract. Considering the relevance of the matter 32 articles were opted for the present review.

Lupus panniculitis is usually difficult to treat, and the patient is often put on multiple immunosuppressives with variable clinical response and relapses, notwithstanding the long-term side effects. We describe two cases of refractory lupus panniculitis which have been treated successfully with rituximab which is a chimeric anti-CD20 antibody. It reduces the number of circulating mature B-cells, thereby reducing the autoantibodies and the mediators of inflammation. Rituximab is a good alternative to patients who are not responsive to conventional treatment options for lupus panniculitis. There have been few side effects reported by the patients, but the clinical response and psychological well-being clearly outweigh them.

Background: Gallbladder cancer (GBC) is one of the leading cancers among gastrointestinal malignancies. GBC occurs more frequently in females worldwide. There are very few studies on the incidence of GBC in the state of Rajasthan. The present study evaluates its temporal variation and area-wise distribution. Materials and Methods: Five-year retrospective data on GBC incidence were obtained from Hospital-Based Cancer Registry of Regional Cancer Centre (RCC), Bikaner, from January 2014 to December 2018. Linear regression was applied to determine the trend of GBC incidence over these 5 years. District- and tehsil-wise distribution of patients was also analyzed. Results: Of 31,553 cases registered at RCC, Bikaner, from January 2014 to December 2018, there were 1199 cases of GBC accounting for 3.8% of the total. Among these, there were 333 males and 866 females which contributed approximately 1.8% and 6.4% of all male and female cancer cases, respectively. The median age at the diagnosis of GBC was 60 years in both the sexes. Linear regression analysis showed an increasing trend of GBC incidence over 5 years. The highest incidence rate was found in the districts of Sri Ganganagar, Hanumangarh, and Bikaner, with most patients coming from Ganganagar and Suratgarh tehsils of Sri Ganganagar district. Conclusion: GBC cases have shown an increasing trend in the past 5 years in Rajasthan with a higher incidence in the North-Western districts irrigated by canal water. There is a need to correlate the water chemistry and find out solutions for reducing the risk of GBC in future.

Purpose: As of from 30 Jan to 31 May, 2020, more than 182,143 confirmed cases reported in India along with 86,984 recovered cases and 5164 deceased cases of COVID-19. More than 53 countries are also affected with this pandemic virus. However, the lack of specific drugs to prevent/treat this pandemic disease is a major problem at this current scenario. In this regard, this systemic review was conducted to identify the therapeutic approaches and researches which are ongoing in India against COVID-19. Methods: We had screened Google Scholar database with the keywords nCoV, corona virus in India, effect of SARS-CoV-2 in India, 2019-nCoV, treatment pattern in India for nCoV and therapy used to treat nCoV in India. In the final review we had included a total of 49 articles. Results: As a result we had found that Indian Council of Medical Research and NIH have given a standard guideline of Hydroxychloroquine and other antiviral drugs for nCoV, and also there are various researches going on related to nCoV treatment like, chemicals from natural products, herbs and spices commonly used in India, combination therapy of lopinavir and ritonavir, ultra-violet radiation therapy, molecular dynamic (MD) simulations of molecules for vaccine preparation, Convalescent plasma transfusion (CPT) therapy and many more. Conclusions: New drugs and therapy are in the premature stage for this hazardous pandemic. We need more time to gain the detailed knowledge of the life cycle of the nCoV, which can speed up the drug/vaccine development process against nCoV.

Objective -Plants contain numerous biologically active compounds, many of these have been shown to exhibit therapeutic and antimicrobial properties and therefore they were in use as antimicrobial drugs in traditional medicines. Euphorbia neriifolia Linn. belongs to the family Euphorbiaceae. Assessment of medication implies affirmation of its personality and assurance of its quality and virtue and recognition of nature of debasement. Throughout the years the nature and level of assessment of rough medications has experienced an efficient changes. Hence, in the present study an attempt has been made for effectual qualitative evaluation of dried powdered leaves and stem of Euphorbia neriifolia Linn. by fluorescence analysis. Design & Intervention- The dried powdered sample of Euphorbia neriifolia Linn. leaves and stem has been used to perform fluorescence analysis under the visible day light and UV light of short wavelength (254 nm) and long wavelength (365 nm) for their characteristic colour. Main outcome measures- The ultra violet light creates fluorescence in numerous common items, which don't noticeably fluoresce in sunshine. In the event that the substances themselves are not fluorescent, they may frequently be changed over into fluorescent subordinates or disintegration items by applying diverse reagents. The hues created by these reagents speak to the nearness of dynamic constituents. Results- The fluorescence character of any powdered character of any powdered medication is exceptionally particular and supportive distinctive highlights for the assurance of a medication. Conclusion- The dried powder and herbal extracts of Euphorbia neriifolia Linn. leaves and stem showed varied fluorescence character which is an essential parameter for standardization of herbs. Keywords: Euphorbia neriifolia Linn., Standardization, Fluorescence analysis, Evaluation, Euphorbiaceae.

A prerequisite for nerve-sparing pelvic surgery is a thorough understanding of the topographic anatomy of the fine and intricate pelvic nerve networks, and their connections to the central nervous system. Insights into the functions of pelvic nerves will help to interpret disease symptoms correctly and improve treatment. In this article, we review the anatomy and physiology of autonomic pelvic nerves, including their topography and putative functions. The aim is to achieve a better understanding of the mechanisms of pelvic pain and functional disorders, as well as improve their diagnosis and treatment. The information will also serve as a basis for counseling patients with chronic illnesses. A profound understanding of pelvic neuroanatomy will permit complex surgery in the pelvis without relevant nerve injury.

Unicornuate uterus with pregnancy in the noncommunicating rudimentary horn is extremely rare. Diagnosis requires awareness, high suspicion index, 3D ultrasound, and MRI. If missed, it can be catastrophic. Treatment varies across literature. We present a case where detection was done by 3D ultrasound and primary laparoscopic surgery done for treatment., All pregnant women should be eyed with suspicion of a mullerian anomaly and ectopic pregnancy. Being aware is the key to avoid catastrophes. A good ultrasound, 2D with 3D confirms diagnosis. Laparoscopic intervention is a good treatment choice.

Background: Vision impairment remains a major health problem worldwide. Elevated intraocular pressure is a prime risk factor for blindness in the elderly. Netarsudil is a Rho-associated protein kinase (ROCK) inhibitor, which also inhibits norepinephrine transport. This narrative review summarizes the properties and clinical significance of netarsudil, a promising drug in topical glaucoma therapy. Methods: We searched PubMed, Medline and Scopus databases using relevant keywords to retrieve information on the physicochemical properties, formulation, mechanism of action, clinical pharmacokinetics, dose and toxicity of netarsudil. Results: Netarsudil showed promising effects in lowering the elevated intraocular pressure by two mechanisms. The US FDA approved netarsudil for clinical use in 2017 under the trademark of Rhopressa® while European Medicines Agency approved Rhokiinsa® in 2019. This drug is available as a 0.02% ophthalmic solution for once-daily topical application. Conclusion: The discovery of netarsudil is a breakthrough in the therapy of glaucoma with proven efficacy in a wide range of eye pressures and is well tolerated in cases with ocular hypertension and chronic glaucoma.

Learning curves for endoscopic surgery are long and flat. Various techniques and methods are now available for surgical endoscopic training, such as pelvitrainers, virtual trainers, and body donor surgery. Video modeling and video feedback are commonly used in professional training. We report, for the first time, the application of video modeling and video feedback for endoscopic training in gynecology. The purpose is to present an innovative method of training. Attendees (residents and specialists) of minimally invasive surgery courses were asked to perform specific tasks, which were video recorded in a multimodular concept. Feedback was given later by an expert at a joint meeting. The attendees were asked to fill a questionnaire in order to assess video feedback given by the expert. The advantages of video feedback and video modeling for the development of surgical skills were given a high rating (median 84%, interquartile ranges (IQR) 72.5&ndash, 97.5%, n = 37). The question as to whether the attendees would recommend such training was also answered very positively (median 100%, IQR 89.5&ndash, 100%, n = 37). We noted a clear difference between subjective perception and objective feedback (58%, IQR 40.5&ndash, 76%, n = 37). Video feedback and video modeling are easy to implement in surgical training setups, and help trainees at all levels of education.

Nipecotic acid is considered to be one of the most potent inhibitors of neuronal and glial-aminobutyric acid (GABA) uptake in vitro. Due to its hydrophilic nature, nipecotic acid does not readily cross the blood-brain barrier (BBB). Large neutral amino acids (LAT1)-knotted nipecotic acid prodrug was designed and synthesized with the aim to enhance the BBB permeation by the use of carrier-mediated transport. The synthesized prodrug was tested in animal models of Pentylenetetrazole (PTZ)-induced convulsions in mice. Further pain studies were carried out followed by neurotoxicity estimation by writhing and rota-rod test respectively. HPLC data suggests that the synthesized prodrug has improved penetration through BBB. Nipecotic acid-L-serine ester prodrug with considerable anti-epileptic activity, and the ability to permeate the BBB has been successfully synthesized. Graphical Abstract.

Diabetes mellitus is one of the aggressive disorders in global society. No pharmacotherapy is available for permanent diabetes cure, although management is possible with drugs and physical activities. One of the recent complications noticed in type 2 diabetes mellitus includes diabetes-induced Alzheimer. It has been proposed that the possible diabetes-induced Alzheimer could be of type 3 diabetes. A variety of cross-sectional studies have proved that type 2 diabetes mellitus is one of the factors responsible for the pathophysiology of Alzheimer. New drug molecules developed by pharmaceutical companies with adequate neuroprotective effect have demonstrated their efficacy in treatment of Alzheimer in various preclinical diabetic studies. Patients of type 2 diabetes mellitus may show the benefit with existing drugs but may not cause complete cure. Extensive studies are being carried out to find new drug molecules that show their potential as antidiabetic drug and could treat type 2 diabetes–induced Alzheimer as well. This review provides an overview about the recent advancement in pharmacotherapy of diabetes-induced Alzheimer. The pathomechanistic links between diabetes and Alzheimer as well as neurochemical changes in diabetes-induced Alzheimer are also briefed.

Background: Radiotherapy in head-and-neck cancer (HNC) is a challenging task, and the anatomical alterations occurring during the course of intensity-modulated radiotherapy (IMRT) can be compensated by adaptive radiotherapy (ART) which utilizes repeat computed tomography (CT) scans during the treatment course for replanning. In this study, the clinical and dosimetric benefits of ART were compared with the conventional IMRT. Materials and Methods: Sixty patients with locally advanced HNC were randomized into two arms to receive IMRT up to a curative dose of 70 Gy with concurrent weekly chemotherapy and were prospectively analyzed between March 2018 and March 2019. Repeat CT scan was acquired after the 3rd week of radiation. Patients in the study arm underwent replanning, whereas those in the control arm continued with the first IMRT plan. Assessment was done weekly till the end of treatment and at 1, 3, and 6 months post IMRT for disease response and toxicities. Tumor volume reduction rate (TVRR) and dose reduction to organs at risk were also recorded. Results: Complete response was observed in 90% and 96.7% patients in the control and study arms, respectively, at the end of 6 months. Insignificant differences were found between the two arms in terms of toxicities. Xerostomia was statistically significantly higher in the control arm at 6 months (P = 0.01). TVRR was found to be 31.85%. Dose to spinal cord, ipsilateral, and contralateral parotid reduced by 4.3%, 6%, and 2.2%, respectively, with ART. Conclusion: Mid-treatment adaptive replanning can help in better target coverage and minimize toxicities in HNC patients.

Burkholderia is a gram-negative bacillus causing infections in immunocompromised patients. It is commonly seen in the tropics and is known to mimic tuberculosis clinically. Six patients were reviewed who were admitted in our hospital between July 2018 to June 2019 after obtaining their consent. All the six patients were uncontrolled diabetics with HbA1c levels between 8.2-13.9% who presented with fever more than 2 weeks and had abdominal symptoms like vomiting, abdominal pain or loss of appetite. Some also had respiratory symptoms like cough, chest pain and breathlessness. All of them had leucocytosis (neutrophilic). Mild transaminitis was also observed. CT abdomen revealed presence of multiple hepatic and splenic abscesses in all the patients. Chest X-ray revealed bilateral pneumonia in five patients. Burkholderia cepacia was found in the blood of four patients, sputum of one patient and splenic pus aspirate of one patient. Four patients were treated with meropenem and rest with ceftazidime. All of them responded well to treatment and became asymptomatic. Ultrasonography abdomen at follow-up was negative for any intra-abdominal abscesses. They were also put on long term oral co-trimoxazole. The clinical presentation of Burkholderia closely mimics tuberculosis as it predominantly affects immunocompromised and causes a long-duration multi-systemic illness. There has been several case series of intra-abdominal abscesses caused by Burkholderia pseudomallei but infections by Burkholderia cepacia in the abdomen is a rare finding. The diagnosis of burkholderia is often delayed due to its inconspicuous nature, lack of clinical suspicion and often mimicking tuberculosis clinically.

Introduction: Scrub typhus is a re-emerging illness in the South-East Asia and other parts of the world caused by Orientia tsutsugamushi, which is a mite-borne bacterium belonging to the Rickettsiaceae family. It has varied clinical manifestations and affects multiple organ systems. In Asia, about 1 million new cases are identified annually. Aim: The aim was to conduct a retrospective study to observe the clinical profile and complications of scrub typhus in South-Eastern India. Materials and Methods: Clinical data of 240 patients who were 18 years of age or above, admitted in the Department of Internal Medicine and diagnosed with scrub typhus by means of IgM Enzyme-linked Immune Sorbent Assay (ELISA) was collected. Demographic profile, clinical signs and symptoms, laboratory parameters, co-infections and complications were reviewed. Statistical analyses were performed using Chi-square test. Results: Majority of the patients were males, between the age of 18-29 years and lived in rural areas. Forty-three (17.9%) patients were admitted in the ICU and the remaining in wards. Sixty-nine (28.8%) patients had consolidation and 11 (4.6%) had Acute Respiratory Distress Syndrome (ARDS). Twenty-one (8.8%) patients had jaundice and 76 (31.7) had hepatomegaly. Twenty-one (8.8%) patients had meningo-encephalitis and 18 (7.5%) had acute kidney injury. Twelve (5%) patients had co-infection with dengue and 8 (3.3%) had malaria. Conclusion: This study shows wide and varied presentation of scrub typhus infection along with the course of the disease and response to the treatment. The diagnostic clues such as fever, eschar, rashes, lymphadenopathy should be kept in mind by a primary care physician as early recognition and treatment can prevent its dangerous complications and reduce the mortality due to the disease. Occurrence of co-infections should also be kept in mind for better management of the patient.

Introduction: The estimated prevalence of Hypomagnesemia in Type 2 Diabetes Mellitus (T2DM) ranges between 14% to 48% in various studies. Hypomagnesemia has been found to be associated with increased insulin resistance in patients of T2DM. Aim: The aim was to estimate fasting serum magnesium levels in the patients of T2DM and to correlate serum magnesium with glycaemic status and nephropathy status. Materials and Methods: It was a cross-sectional study conducted at KIMS, Bhubaneswar between October 2017 to September 2019 which included a total of 187 T2DM patients. The glycaemic status was assessed by HbA1c and subdivided into good (HbA1c 9%). The nephropathy status was assessed by urine Albumin-Creatinine Ratio (ACR) and subdivided into macroalbuminuria (Urine ACR >300 mg/g), microalbuminuria (Urine ACR 30-299 mg/g) and non-nephropathy (Urine ACR

Lymph node involvement has been shown to be one of the most relevant prognostic factors in a variety of malignancies; this is also true of endometrial cancer. The determination of the lymph node status is crucial in order to establish the tumor stage, and to consider adjuvant treatment. A wide range of surgical staging practices are currently used for the treatment of endometrial cancer. The necessity and extent of lymph node dissection is an ongoing controversial issue in gynecological oncology. Lymph node surgery in endometrial cancer is technically challenging, and can be time consuming because of the topographic complexity of lymphatic drainage as such, and the fact that the lymph nodes are directly adjacent to both blood vessels and nerves. Therefore, profound and exact knowledge of the anatomy is essential. Sentinel lymph node mapping was recently introduced in surgical staging with the aim of reducing morbidity, whilst also obtaining useful prognostic information from a patient’s lymph node status. The present review summarizes the current evidence on the role of lymph node surgery in endometrial cancer, focusing on the embryological, anatomical, and technical aspects.

Retinoblastoma is the most common primary intraocular malignancy of childhood. The present study was undertaken to overcome the scarcity of data regarding the epidemiology, demographic and clinical profile, and nature of the first health-care professional consulted.A retrospective analysis of medical records was performed for all cases of retinoblastoma who presented to the department of ophthalmology and oncology between 2010 and 2017. A total of 54 cases were reviewed.Unilateral disease was seen in 85.2% while 14.8% presented with bilateral disease with a median age of 3 years and 2 years, respectively, at diagnosis. The male: female ratio was 2:1. The most common presenting symptom was leukocoria which was noticed in 42 patients (77.7%), followed by red eye (33.3%) and proptosis (20.3%). The most common stage of presentation was Stage I (44.4%), followed by Stage IV (20.4%), Stage III (9.3%), and Stage II (5.6%). The median time to diagnosis was 8.7 months (range, 0.5-98.7 months), and the median time to treatment was 37.4 days (range, 0-645 days). Majority of the patients were referred by local ophthalmologists (48%), followed by general practitioners (20%), nurses (19%), and quacks (13%). Enucleation was the most preferred treatment modality (48.1%), followed by chemotherapy (33.3%), radiotherapy (13%), photocoagulation (3.7%), and exenteration (1.9%). The overall remission rate was 79.6%, while 12.3% had relapse and 7.4% died.The study showed a dire need for timely detection and treatment of retinoblastoma which is possible with improved awareness and better accessibility to health-care facilities. It also revealed a decrease in histopathological risk factors with chemoreduction.

Eighty percent of leg ulcers have a vascular aetiology. These ulcers are often debilitating for the patients and difficult to treat owing to lack of clinical suspicion leading to significant morbidity and mortality. Here we report a case of bilateral leg ulcers in a young female with Anti Phospholipid Syndrome (APS). She also had associated Evans’ syndrome in the absence of lupus. She responded well with oral anticoagulant and immunosuppressives on follow-up after 6 weeks and 12 weeks. Thus, APS should be kept in mind while evaluating a case with leg ulcers in a young patient as in the present case.

BACKGROUND AND OBJECTIVE: Thrombocytosis is not an uncommon finding in hemograms of children with an incidence of 6%–15% among hospitalized children. This study aims to determine the etiology of thrombocytosis and analyze various platelet parameters in children attending our hospital. MATERIALS AND METHODS: A prospective observational study was carried out in a tertiary care center in Odisha, in eastern part of India, for 6 months from July 2016 to December 2016. All children of age group 1–14 years of age attending pediatrics and other pediatric super specialty outdoors and/or admitted to indoors and whose complete blood counts (CBC) were done were included in the study. The CBC parameters such as hemoglobin, red blood cell indices, and platelet indices (platelet distribution width [PDW], mean platelet volume [MPV], platelet large cell ratio [P-LCR]) were noted. RESULTS: Out of 2500 hemograms done in pediatrics age group, 272 (10.8%) patients showed thrombocytosis. About 99.6% of cases were of secondary thrombocytosis. Only one case of primary thrombocytosis was encountered. The most common cause of secondary thrombocytosis was infection (39.5%) alone followed by iron deficiency anemia (14.1%). With increasing platelet counts, a decrease in MPV, P-LCR, and PDW was noted which was statistically significant (P < 0.05). CONCLUSION: Thrombocytosis is not rare (10.8%) in children. Secondary thrombocytosis is common and predominatly attributed to infection.

Mixed connective tissue disease (MCTD) is an autoimmune condition characterized by mixed clinical features of connective tissue diseases like systemic lupus erythematosus, polymyositis or systemic sclerosis with high titers of anti-U1 small nuclear ribonucleoprotein. Interstitial lung disease is a frequent manifestation of MCTD. Retroperitoneal fibrosis (RPF) is a rare fibro-inflammatory process involving the retroperitoneum. Majority of the cases are idiopathic and the rest are secondary to malignancies, infections or drugs. In this article, we describe a rare occurrence of RPF with MCTD.