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A hiatal hernia (HH) occurs when a portion of the stomach slides up into the thorax through the esophageal hiatus of the diaphragm. Most of these hernias are acquired and result from factors which increase the intra-abdominal pressure resulting in laxity of phreno-esophageal ligament and an increase in size of the esophageal hiatus. HHs are classified into 4 types. Type-1 HH is the commonest and frequently associated with gastroesophageal reflux disease (GERD). Type-4 HH is rare and is prone to develop mechanical complications such as gastric volvulus and obstruction. Awareness and early diagnosis and treatment of these complications can reduce morbidity and mortality and ensure a positive outcome.

Treacher Collins syndrome is an autosomal dominant genetic disorder that results from improper development of the first and second pharyngeal arches. Disruption in the formation and migration of neural crest cells leads to facial malformation. Face shows a convex profile with hypoplastic malar bones as well as mandibular hypoplasia. Eyes typically have antimongoloid slant often with lower lid coloboma. External ear is deformed and patients often suffer from conductive deafness. Respiratory distress is common due to hypoplastic facial bones. Though intelligence remains unaffected, such patients are susceptible to depression. Management of these patients require multidisciplinary approach to ensure a decent quality of life.

The development of a biosimilar is based on comparative structural, physicochemical, functional and clinical assessments. The sum of these analyses encompasses the ‘totality of evidence’, which demonstrates no clinically meaningful differences between the biosimilar and the reference product (RP). Once biosimilarity has been established, provided there is suitable scientific justification, clinical data may be extrapolated to other indications of the RP. AVT02 has been developed as a biosimilar to high-concentration, low-volume Humira (adalimumab), an anti-tumour necrosis factor-alpha monoclonal antibody approved for various chronic inflammatory indications. The totality of evidence for AVT02 is described, supporting its approval as an adalimumab biosimilar for all approved indications globally. Analytical similarity assessments using mass spectrometry methods demonstrated identical amino acid sequences for AVT02 and the RP, with high similarity in terms of primary structure, post-translational modifications and higher-order structural attributes. The mechanism of action was assessed by various cell-based potency assays and binding assays, and the results demonstrated that AVT02 is highly similar to the RP. No clinically meaningful differences in terms of purity, potency and safety were observed, and minor differences in a few physiochemical attributes did not impact the in vitro biologic activity and were not considered clinically relevant. Clinical similarity was demonstrated by comparing the pharmacokinetic, efficacy, safety and immunogenicity profiles of AVT02 with those of the RP. Clinical studies supported similar pharmacokinetic and comparable immunogenicity profiles between AVT02 and the RP in healthy participants and participants with moderate-to-severe chronic plaque psoriasis, with no new safety signals detected. The totality of evidence described demonstrates the biosimilarity of AVT02 to the RP, thereby fulfilling the scientific and regulatory requirements for AVT02 as a high-concentration biosimilar for the treatment of chronic plaque psoriasis and all approved indications of the RP.

Nowadays, the search for new chemotherapeutic agents with low toxicity and high selectivity is a major concern. In this paper, we report the synthesis and characterization of a hybrid thiosemicarbazone/hydrazone ligand in its neutral form (L1H2) and as the chloride salt ([L1H3]Cl)-, three diorganotin (IV) complexes, and one complex with Sn (IV). The compounds have been fully characterized by IR, mass spectra, 1H, 13C, and 119Sn NMR, 119Sn CP/MAS NMR, and by single crystal X-ray diffraction. The organotin compounds have the empirical formula [SnR2L1] (R = Me, Bu, and Ph), but in the solid state, they are polymeric species with seven coordination number due to weak coordination of the pyridine nitrogen, whereas in solution, the polymeric structure is lost to afford hexacoordinate monomeric species. Reaction with SnI4 yields complex [Sn (L1)2]·EtOH, with the metal in a distorted dodecahedral arrangement. We have evaluated the antiproliferative activity of the two forms of the ligands and the four coordination compounds against MDA-MB-231, HeLa, PC3, and HepG2 cancer cell lines, and WI-38 normal cell line, and all the compounds present higher activity than cisplatin, used as the standard control. To investigate the mode of action, we have selected the most active complex, containing phenyl substituents, and used the triple negative breast cancer cell line MDA-MB-231. The results show that the complex induces apoptotic cell death promoted by generation of reactive oxygen species and by disruption of mitochondrial membrane potential.

Background: Development of the human fetal stomach starts at the 4th week of intrauterine life. The knowledge of histogenesis of the musculature of the stomach is important for understanding, diagnosis, and treatment of gastric adenomyoma, congenital anomalies like congenital hypertrophic pyloric stenosis, and abnormalities in the development of the enteric nervous system. The aim of this study was to find out the histogenesis of the submucosa (SM), muscularis mucosa (MM), and muscularis externa (ME) in the human fetal stomach. Methodology: Sixty-three freshly aborted fetuses which were free from any gross abnormality were collected from the obstetrics and gynecology department and studied for 2 years. The fetuses were dissected, the stomach was removed, and the tissue was processed for a histological study. Staining was done by hematoxylin and eosin, Masson's trichrome, and Van Gieson's stain. Slides were studied under Zeiss branded light microscope using ×10 and ×40 objectives. Results: MM was discontinuous initially and became well defined by 21 weeks in the fundus and body and by the 23rd week in the pyloric region. The density of collagen fibers increased gradually in SM and was seen in bundles from the 23rd week onward. The thickness of SM was more than ME till 22 weeks, and after 27 weeks, it was less than that of ME. In the fundus and body of the stomach, till 18 weeks, ME consisted of two layers, with the inner oblique layer being thicker than the circular layer. The circular layer thickened gradually, and the longitudinal layer appeared by the 25th week. In the pyloric region, initially, there was only a circular layer. The oblique and longitudinal muscle layers appeared at 17–18 weeks and 25th week, respectively. The thickness of the circular layer was found to be more than that of the body from the 21st week onward and became much thicker at around the 27th week. The histological feature of MM, ME, and SM of the stomach resembled an adult pattern by the 28th week of gestational age. Conclusion: The findings of the present study about the time of appearance and further development of MM and ME and the thickness and formation of SM of the human fetal stomach are quite comprehensive. These findings are expected to aid in the knowledge of histogenesis of the stomach in the human fetuses and help in the diagnosis and treatment of various congenital anomalies and clinical conditions involving gastric connective tissue and musculature.

Sternal foramen is a common developmental anomaly of the sternum, resulting from impaired fusion of the two mesenchymal halves. Though most cases are harmless and only detected incidentally, proximity to heart and lungs may lead to hazardous complications like pneumothorax or cardiac tamponade during acupuncture or sternal puncture procedures. Sound anatomical knowledge of the sternum and pre-procedural screening may help minimize the risk of these complications.

Introduction: Anatomical knowledge is very crucial to the practice of medicine; thus, its acquisition is foundation base for clinical subjects. Many studies have shown that cadaveric dissections strengthen respect and empathy among medical students. Many students felt the stress and anxiety due to online teaching classes during the pandemic Material and methods: This cross-sectional study was conducted among first year MBBS students of Gujarat Adani Institute of Medical Sciences, Bhuj, Gujarat, India, during 2020-2021. Informed consent was taken from the students when they came back to offline classes after the pandemic was controlled Results: Students were of opinion that offline teaching is more stimulating, it is easy to engage with teacher and more interaction and doubt can be cleared. But during online teaching fear of facing teacher was less in minds of students. The disadvantages which are associated with online teaching as per our study were mostly poor internet connection and less interactivity with teacher. Regarding advantages of online teaching, students were most happy with flexibility of location and comfort of home. Other few advantages were time and cost saving due to travel. Conclusion: The present study revealed that for anatomy being a vast subject, online teaching cannot replace the offline teaching. But in current corona pandemic, online teaching is the only way out. To make online teaching effective it should be more interactive and practical topic has to be revised on specimens and models when students are back to offline classes. The exams should not just include MCQs but also viva and assignments.

Abstract Background Postpartum family planning (PPFP) helps women space childbirths, increase exclusive breastfeeding and prevent unintended pregnancies, leading to reduction in maternal, infant and child morbidities and mortality. Unmet need of family planning is highest among women in the postpartum period due to lack of knowledge, cultural and religious barriers, access barriers and low antenatal care service utilization. However, in spite of low prevalence of postpartum family planning practices, birth-to-birth interval is reportedly high in Delhi, India. This study explores the postpartum contraception practices and the relationship between use of postpartum contraception and subsequent child linear growth. Methods This is a mixed method cohort study on PPFP and is nested within an ongoing “Women and Infants Integrated Interventions for Growth Study” (WINGS). Married women aged 18–30 years who have delivered a live baby are recruited for quantitative interviews at 6 weeks, 6, 12, and 24 months postpartum. In-depth interviews are conducted with a randomly selected sub-sample of women at each of the four time points, 35 husbands and 20 local service providers to understand their perspectives on PPFP practices. Discussion The findings from the study will provide useful insights into couples’ contraception preferences and choice of contraception, modern and traditional, initiation time and the effect of birth spacing and contraception use on subsequent linear growth of the child. This knowledge will be of significant public health relevance and will help in designing appropriate interventions for appropriate postpartum contraception use and delivery strategies. The study aims to work address the Sexual and Reproductive Health and Rights goal of promoting reproductive health, voluntary and safe sexual and reproductive choices for women. Trial registration Trial registration number: CTRI/2020/03/023954 .

Background: Caesarean section (C-section) delivery is a serious maternal health concern in the long run. Notedly, there is a lack of studies dealing with understanding the ways and reasons of C-section deliveries becoming a public health issue in today's time in India and the measures to reduce the unnecessary caesarean sections. We have conducted this study to study the changes in the state-wise prevalence of C-section deliveries in India and understand C-section delivery's socioeconomic and biomedical predictors. Materials and Methods: The study uses data from the fourth and fifth rounds of the National Family Health Surveys (NFHS). The per cent differences in the C-section deliveries from NFHS-4 to NFHS-5 across the states were measured through relative changes. The association between the C-section delivery and socioeconomic and biomedical factors were assessed using multiple logistic regression. Results: This study revealed that the C-section deliveries are higher in the southern states than in the other parts of India. Literacy plays a vital role in C-section deliveries. The probabilities of C-section deliveries are more in 30–40 and 40 + years. The women belonging to the median wealth index category were more likely (OR–CI, 1.62 [1.55–1.66]) to undergo the C-section followed by the women from wealthy households (OR–CI, 1.46 [1.41–1.52]). Conclusion: The Government's health policymakers should take the initiative to reduce the C-section section delivery by means of building maternal health literacy and awareness among women and the community so that its future implications can be minimised. It is crucial to formulate a mandate and implement it in the states where C-sections are too high through community health workers and primary care providers.

ObjectiveTo estimate utilization of maternal, perinatal healthcare services after the lockdown was implemented in response to the COVID-19 pandemic compared to the period before.MethodsThis study conducted in Dakshinpuri, an urban neighborhood in Delhi, reports data over a 13-month period which includes the period “before lockdown” i.e., October 1, 2019 to March 21, 2020 and “after lockdown” i.e., March 22 to November 5, 2020. The period “after lockdown” included the lockdown phase (March 22 to May 31, 2020) and unlock phase (June 1 to November 5, 2020). Mothers delivered during this period in the study area were interviewed using semi-structured questionnaires. In-depth interviews (IDIs) were conducted in a subsample to understand the experiences, challenges, and factors for underutilization of healthcare services.FindingsThe survey covered a total population of 21,025 in 4,762 households; 199 eligible mothers (mean age 27.4 years) were interviewed. In women who delivered after lockdown against before lockdown, adjusted odds of having >2 antenatal care visits in the third trimester was 80% lower (aOR 0.2, 95% CI 0.1–0.5); proportion of institutional deliveries was lower (93 vs. 97%); exclusive breastfeeding during first 6 months of birth (64.5 vs. 75.7%) and health worker home visitation within 6 weeks of birth (median, 1 vs. 3 visits) were substantially lower. Fear of contracting COVID-19, poor quality of services, lack of transportation and financial constraints were key issues faced by mothers in accessing health care. More than three-fourth (81%) of the mothers reported feeling down, depressed or hopeless after lockdown. The major factors for stress during lockdown was financial reasons (70%), followed by health-related concerns.ConclusionCOVID-19 pandemic-related lockdown substantially affected maternal and perinatal healthcare utilization and service delivery.

Background The impact of infertility on mental, emotional, physical and sexual health is grave, particularly in a pronatalist society. Literature is replete with evidence of wide ranging psychosocial consequences of infertility in women, indicating the need for identifying the gaps and designing appropriate context specific interventions to improve access and utilization of services. Data that are accessible, primarily from infertility clinics and women visiting hospitals for infertility treatment; information from community settings is rare. This is a protocol paper for a study to understand women’s experiences and actions taken by them to cope with delayed conception. Methods Mixed-methods cross-sectional design is used to obtain deep insights into the experiences of delayed conception, coping mechanisms, medical assistance and other help sought. Information is also being obtained on socio-demographic profile, fertility intentions, fertility quality of life, general medical history, obstetric, gynecological and sexual history, substance use and mental health status. A sample of 1530 women will be administered 4 modules of a quantitative survey. Focus group discussions, about four or till saturation point, will be conducted using purposive sampling. The study is recruiting from a population of women who previously participated in the ‘Women and Infants Integrated Interventions for Growth Study (WINGS) and failed to conceive during 18 months follow up period. Data collected through questionnaire will be assembled, cleaned, analyzed and reported. The findings will be disseminated through reports with the ethics review committee, government entities, academic and research publications. Discussion This study will provide insights on the experiences and coping strategies of women with delayed conception in the study community. Results will assist in designing appropriate interventions to meet the holistic health and psychosocial needs of women with delayed conception and promote sexual and reproductive health within the broader framework of Sustainable Development Goals and Universal health coverage. Trial registration Trial registration number: CTRI/2020/03/023955.

Background and Aims: Human fetal olfactory bulbs have a six layered laminar architecture where mitral cells are the largest neurons. Volume of the bulbs is considered as an indicator of olfactory function. Fetal bulb cell transplants are used to treat many diseases of the central nervous system. The present study aims to trace the development of the fetal bulbs with respect to it’s gross appearance, volume, arrangement and the number of mitral cells. Materials and Methods: Sixty two normal fresh aborted fetuses were collected from Obstetrics and Gynaecology department of Regional Institute of Medical Sciences, Impbal. The fetuses were dissected and olfactory bulbs were gently taken out and fixed in 10% formal saline. Once fixed, the volume of the bulbs were measured using a measuring cylinder and insulin syringe. This was followed by tissue processing and staining with Toluidine Blue and Cresyl Violet, Stained slides were photographed and number of mitral cells were counted using Image J software. The correlation of bulb volume with fetal age, crown rump length [CRL] and fetal body weight was analysed using SPSS software. Similar analysis was also done between mitral cell number and fetal age. Result: Fetal bulbs attained adult morphology at 20 weeks. Bulb volume was found to rise significantly with advancing fetal age until it slowed down 32 weeks onwards. Mitral cells were identifiable at 16 weeks and maintained a laminar arrangement and showed progressive increase in number until 28 weeks. There after the orderly arrangement of cells as well their number declined. Conclusion: Very few studies have been conducted so far regarding the fetal olfactory bulbs in India. The present study is expected to supplement known data and knowledge regarding the development of the fetal bulbs and the mitral cell population and help in the diagnosis and treatment of central nervous system diseases.

Background and aims: Human fetal stomach starts developing at 4th week of gestational age. The precise knowledge of development of gastric mucosa is important for better understanding, diagnosis and treatment of different clinical conditions like Intestinal metaplasia, pernicious anaemia, heterotopic pancreatic tissue, atrophic gastritis etc. All these conditions are related to anomalous histogenesis of stomach. The aim of the study was to find out development of lining epithelium, gastric pits and glands and their ratio, time of appearance of different gastric mucosal cells in different weeks of gestation. Materials and methods : Sixty three normal fresh aborted fetuses were collected from obstetrics and gynaecology department of Regional Institute of Medical Sciences, Imphal. The fetuses were dissected and stomach was gently taken out, fixed in 10% normal saline and Bouin’s fluid followed by processing of the tissue. Staining was done with Haematoxylin and Eosin and Masson’s Trichrome. Results : The lining epithelium of stomach was seen to be simple cuboidal at 15 to 16 weeks which changed to columnar at 17th week of age. Gastric pits were seen to be very shallow in fundic part at 15th week and attained adult pattern by 28th week where as in pyloric part pits were deeper than fundic part from 17th week onwards. Parietal cells were first appreciated by 19th-20th week, chief cells and mucous neck cell were first seen by 25th-26th and 23rd-24th weeks respectively. Entero- endocrine cells were seen from 26th week onwards. No finding was suggestive of intestinal metaplasia or heterotopic pancreatic tissue or any other histogenetic anomaly. Conclusion : Very few studies have been conducted so far regarding histogenesis of human fetal stomach in India. The present study is expected to supplement known data and knowledge regarding histogenesis of human fetal stomach and help in diagnosis and treatment of related congenital anomalies.

Background and aims: The morphology of human stomach is subjected to wide variations and changes during developmental stage . Congenital anomalies of stomach like hypertrophic pyloric stenosis and thoracic stomach are common in new borns. Some rare anomalies like duplication, diverticula and hypoplasia of stomach also may occur. The present study attempts to analyze the morphological changes like change in shape, height, width, length of greater and lesser curvatures, capacity and localization of stomach in the quadrants of abdomen in different age groups of human foetuses and also to look for congenital anomalies. Materials and methods: Fifty normal fresh still born foetuses of age varying from 15 to 40 weeks were dissected and morphological study was carried out. Parameters like height, width, length of greater and lesser curvature,capacity of stomach were measured and location, shape, internal appearance of stomach were noted. Results: Significant changes in shape and in location of stomach in different quadrants of the abdomen were found in different foetal age groups. Localization of stomach is seen as that in adults by 25th week of foetal age. Typical ‘J’ shaped stomach is seen by 28th week of foetal age. Height, width, length of greater and lesser curvatures and capacity of stomach increased with increasing foetal age. A sudden increase in width was seen at 17th week and a sudden increase in height was noted at 25th week. Well developed rugae and gastric canal were seen in inner surface of stomach by 28th week. Capacity of stomach increased from 1 ml at 15th week to 32 ml at 40th week. Conclusion: The obsevations of the present study show that morphology and location of the stomach in different age groups show great variations. This study may help in study of development of stomach and in diagnosis of different developmental anomalies, ailments and pathology of stomach.

Calcium is an ubiquitous cellular signaling molecule that controls a variety of cellular processes and is strictly maintained in the cellular compartments by the coordination of various Ca2+ pumps and channels. Two such fundamental calcium pumps are plasma membrane calcium ATPase (PMCA) and Sarco/endoplasmic reticulum calcium ATPase (SERCA) which play a pivotal role in maintaining intracellular calcium homeostasis. This intracellular Ca2+ homeostasis is often disturbed by the protozoan parasite Leishmania donovani, the causative organism of visceral leishmaniasis. In the present study we have dileneated the involvement of PMCA4 and SERCA3 during leishmaniasis. We have observed that during leishmaniasis, intracellular Ca2+ concentration was up-regulated and was further controlled by both PMCA4 and SERCA3. Inhibition of these two Ca2+-ATPases resulted in decreased parasite burden within the host macrophages due to enhanced intracellular Ca2+. Contrastingly, on the other hand, activation of PMCA4 was found to enhance the parasite burden. Our findings also highlighted the importance of Ca2+ in the modulation of cytokine balance during leishmaniasis. These results thus cumulatively suggests that these two Ca2+-ATPases play prominent roles during visceral leishmaniasis.

Introduction: Anaemia is a major public health problem affecting women of reproductive age groups all over the world. As per NFHS-IV data, prevalence of anaemia in India is 53% and in urban areas of West Bengal is 58.2%. Studies conducted among women of reproductive age in slums of Mumbai and Bhubaneswar, the prevalence of anaemia was 49.5% and 60.8% respectively. Aim: To assess the nutritional anaemia and its predisposing factors among women of reproductive age group in a slum of Kolkata, West Bengal, India. Materials and Methods: A community based cross-sectional study was carried out in a slum of Kolkata, West Bengal, India. Total study participants enrolled were 122 women of the reproductive age group (15-49 years). The surveyed women were gathered in three days through three different camps organised in the field service area of Urban Health Unit and Training Center, Chetla. All the respondents were interviewed and anthropometric measurement and blood examination were carried out. Data was analysed using SPSS version 16 and chisquare test was used to find out the association between variables. Results: Among all women, 112 (91.8%) had anaemia with proportion of mild and moderate anaemia being 67.2% and 24.6%, respectively. No woman was suffering from severe anaemia. The factors associated with anaemia were age, education, socio-economic status, parity, abortion, interval between two successive pregnancies less than three years, menorrhagia, BMI and dietary habits. Conclusion: The current study noted that education level, socio-economic status, consumption of iron rich food, increased order of pregnancies and abortion, interval between successive pregnancies affect the blood haemoglobin level successively. To increase the health awareness and decrease the prevalence of anaemia, community awareness about iron folic acid supplementation and schooling of girls, decreasing school dropout are to be addressed.