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Covid-19 is an unprecedented challenge in our times leaving a trail of destruction and mayhem affecting almost all of us during the last 2 years. Various data sources are available around the globe to measure its impact using various yardsticks.By carefully looking at data available at the website maintained by Government of India, we can draw some useful conclusions.There is a dip in the number of online registrations at our hospital coinciding with second wave and resultant lockdown.Tracing digital footprints of an event as huge as the Covid pandemic may help us for future planning when we learn its lessons well.

Objective assessments of the effect of mandibular advancement device on patients with obstructive sleep apnea are lacking.The purpose of this clinical study was to compare levels of serum tumor necrosis factor alpha (TNF-alpha), Epworth Sleepiness Scale score, and Berlin Questionnaire score in patients with mild to moderate obstructive sleep apnea before and after treatment with a mandibular advancement device.Twenty participants diagnosed with mild to moderate obstructive sleep apnea based on polysomnography testing were enrolled. A custom nonadjustable mandibular advancement device with 70% mandibular protrusion was provided for each participant for management of the obstructive sleep apnea. Evaluation of TNF-alpha levels was performed before treatment (baseline) and 3 and 6 months after starting mandibular advancement device therapy by using a Human TNF-alpha enzyme-linked immunoassay (ELISA) sandwich kit. The Epworth Sleepiness Scale and Berlin Questionnaire were also filled out by the participants at the same time intervals (α=.05).A statistically significant decline in the levels of TNF-alpha was observed at 3 and 6 months compared with baseline (P.001). The Epworth Sleepiness Scale scores showed a statistically significant reduction at 3 and 6 months compared with baseline (P.001). The risk of obstructive sleep apnea assessed by using the Berlin Questionnaire was found to be significantly reduced at 6 months compared with baseline (P=.001).Patients with mild to moderate obstructive sleep apnea showed reduced levels of TNF-alpha and Epworth Sleepiness Scale and Berlin Questionnaire scores when treated with a mandibular advancement device.

Background Beta (β)-thalassemia major patients frequently suffer from many vascular problems. Thrombophilia is a blood disorder that comprises imbalances in the blood coagulating factor due to ecological and hereditary components. Previous evidence shows that thrombosis is the commonest risk in beta-thalassemia patients. Several studies have examined that MTHFR C677T, prothrombin G20210A (PT G20210A), and Factor V Leiden G1691A (FVL G1691A) polymorphism play a crucial role in the development of β-thalassemia major, yet the result was questionable and uncertain. Therefore, in this study, we executed the correlation between these gene polymorphisms with β-thalassemia major patients. Methods Suitable keywords were used to search related articles in PubMed, Google Scholar, and Web of Science. In this random-effects meta-analysis, we analyzed the odds ratio (OR) for the estimation of risk. Results A total of nine research articles with 645 β-thalassemia major patients and 989 healthy controls were incorporated in this meta-analysis. The pooled OR was assessed in MTHFR C677T, PT G20210A, and FVL G1691A polymorphism. This random-effects meta-analysis demonstrated that MTHFR C677T, PT G20210A, and FVL G1691A gene polymorphism did not significantly associate with β-thalassemia major. Moreover, the heterogeneity was significantly found in genotype CC vs CT+TT C677T (I2=61%) and allele C vs T (I2=71%) of MTHFR and genotype GG vs GA (I2=95%), GG vs GA+AA (I2=95%), GA vs GG+AA (I2=95%), and allele G vs A (I2=93%) of FVL G1691A. Conclusion The results of this meta-analysis show that MTHFR C677T, prothrombin G20210A, and Factor V Leiden (G1691A) gene polymorphism are not a risk factor for β-thalassemia major.

The famous poet, Amir Khusro, said of Kashmir: "If there is heaven on earth, it is here, it is here, it is here". That heaven and crown of India has been under siege now for over four months.

Background: Down syndrome (DS) is the commonest chromosomal anomalies at birth. DS is portrayed by the event of extra complete/deficient duplicate of chromosome number 21 (trisomy 21). Around the world, this disordered influencing roughly 1 out of 1000 infants. Pro-inflammatory and anti-inflammatory cytokines engaged with a few physiological procedures involving the guideline of inflammatory reactions. In DS kids, the creation of few important inflammatory and anti-inflammatory cytokines is altered. Different investigations shows that the cytokines are dysregulated in patients with DS. In this study, we led a meta-analysis to evaluate the connections of pro-inflammatory and anti-inflammatory cytokine changes in youngsters with DS patients. Methodology: We searched PubMed, Google and Web of Science for studies in exploring the association of pro-inflammatory and anti-inflammatory serum level with DS patients. Total 10 studies were included in the meta-analysis. The random effects were used to analyze the pooled data. All statistical tests were two-sided. Results: High circulating level of serum MCP-1 was significantly associated with DS [Cohen's d = 143.91 95% confidence interval (CI) =110.38-177.43]. However, the other circulating cytokines IL-2 and IL-17 level were lower whereas IL-13 level was higher but not significantly different in DS as contrasted to healthy controls. The heterogeneity level was higher in IL-2, IL-13 and IL-17 cytokines. Conclusion: This meta-analysis shows that the higher circulating level of MCP-1 was associated with DS.

Background Himachal Pradesh is a hill state in North India in the Western Himalayas. β-thalassemia is a genetic disorder of hemoglobin inherited in an autosomal recessive manner that results in defective globin production leading to the early destruction of red blood cells. β-thalassemia has long been neglected in Himachal Pradesh due to popular belief that it runs along "Lahore-Gujarat-Punjab" belt in India. Therefore, there is no β-thalassemia testing facility currently in the state. Methods To estimate the prevalence of β-thalassemia carriers, we calculated the sample size based on probability proportional to size self-weighing design. In each of 20 selected colleges, 111 students having an age of 18-25 were tested for high-performance liquid chromatography (HPLC) and complete blood count. Some were further tested for the mutations. We computed sensitivity, specificity, positive predictive value (PPV) and negative predictive value, and receiver operating characteristic curve for mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) red cell parameters. Results Of the 2220 students, 57 were found to be β-thalassemia carrier by HPLC. The overall prevalence rate was 2.6% which translates to probable 180,000 β-thalassemia carriers in Himachal Pradesh. Six districts bordering highly endemic Punjab had a higher prevalence. Hemoglobin D-Punjab, Heterozygous-Iran Trait, and raised fetal hemoglobin were found. Thalassemia major and sickle cell disease were not found. Anemic status or MCV/MCH parameters were not found to be reliable predictors of thalassemia carrier status among the healthy populations of HP. The predominant mutation found was IVS 1-5 G > C. Conclusion Popular ongoing strategy for screening with MCV and MCH has low-PPV and can miss upto 37% of true thalassemia carriers. HPLC is better strategy for screening carriers and reduces further spread of thalassemia.

Background: Vaginitis is one of common medical problem in women that often results in frequent medical consultations. Aim was to study the clinico-epidemiological profile and etiopathogenesis of various causes of vaginal discharge among females in age group 18-45 years residing in rural area of Bhojipura district.Methods: This Hospital based cross sectional study was conducted over a period of one year (March 2011 to February 2012) among 150 females aged 18-45 years presenting with the complaint of vaginal discharge. Information on sociodemographic data was obtained with the aid of questionnaires. Samples were obtained with two dry cotton-wool tipped swabs from vaginal fornices and were sending to department of microbiology.Results: The prevalence rate of vaginal discharge was found to be 24.6% among females in reproductive age group attending the outpatient department from rural background. Out of 150 patients who were enrolled for study 86 (57.30%) were diagnosed with non-infective discharge while 64 (42.60%) patients with infective discharge. Bacterial vaginosis was detected in 25 (39.1%), Candida albicans was detected in 23 (35.9%), T. vaginalis in 4 (6.3%) and mixed infections were found in 12 (18.7%). According to vagina flora morphology 85 (56.6%) had normal morphology, 30 (20%) had shift from normal flora and 35 (23.3%) had definitive bacterial vaginosis. About 20.5% females with Candida based etiology were diabetic.Conclusions: Some common reproductive tract infections can be diagnosed and managed at primary level health facilities. This promotes community awareness through behavior change communication which includes safer sex practices, awareness of HIV and appropriate and timely health care seeking behavior.

BACKGROUND: Oral submucous fibrosis is a chronic progressive scarring disease of oral cavity and oropharynx characterized by epithelial atrophy and juxta epithelial inflammatory reaction with progressive fibrosis of the lamina propria an deeper connective tissue. In india, the first mention of this disease in literature dates back to the time of "Sushruta" as "Vidari". However, in modern literature, Schwartz in 1952 first described it as "atrophica idiopathica mucosaeoris". Antioxidants Protects by physically separating the free oxygen radicals from the susceptible molecules. Providing molecules that effectively compete with the oxygen. Rapidly repair the damage caused by the free radicals. Lysing & inactivating free radicals, removing damaged molecules. Body's multilevel defense systems against free radicals. AIMS & OBJECTIVES: The present study was undertaken to see effect of various antioxidant drugs on oral submucous fibrosis clinically as well histopathologically. MATERIAL & METHODS: This study comprises of 64 patients suffering from oral submucous fibrosis. History, examination and investigation of patients were done in detail as per predesigned proforma. OBSERVATIONS: Submucous fibrosis was seen from 2nd to 6th decade of life. Males were more commonly affected (65.625%) than females (34.375%). The incidence of submucous fibrosis is higher in Hindus (87.5%) than Muslims (12.5%). maximum number of the patients were between 1 and 2 years duration or between 5 and 10 years duration (16 cases in each group. Table shows that 50% of the patients suffering from oral submucous fibrosis had been chewing pan - masala and betel nut. In our series of study maximum cases were of severe grade trismus (32.81%). In this study we gave antioxidants drugs to the patients for a period of 2-3 months. Symptoms of burning sensation of mouth were relieved in 64.51% of cases by antioxidant therapy. Repeated painful ulcerations of mouth were relieved in 70% cases by antioxidant therapy. Suppleness of oral tissue was improved in 80.00% cases by antioxidant therapy. The symptom of trismus was relieved in 26.19% cases by antioxidant therapy. Out of 64 cases of oral submucous fibrosis 36 cases improved on therapy (56.25%) No patient got complete cure by therapy and there were 16 cases who failed on therapy (25%). There were 12 cases (18.75%) that did not come for follow up. CONCLUSION: Thus our work is showing that anti-oxidant drugs are overall favourable for early cases of oral submucous fibrosis clinically as well as histopathologically. So we conclude that anti-oxidant therapy should be regularly used in cases of oral submucous fibrosis.

BACKGROUND: In practical and numerical terms, the solitary nodule is the most important target of thyroid FNAC. Since FNAC can provide an unequivocal benign diagnosis in 60% of patients with benign nodules, its potential to reduce the number of unnecessary operations is significant. Of all the thyroid glands that on surgical resection prove to contain solitary nodules, 70- 80% are benign adenomas and about 10-30% is malignant growth. Over the past two decades, fine needle aspiration cytology (FNAC) has become an essential step in the evaluation of thyroid nodules, due to its superior diagnostic reliability and cost effectiveness. AIMS & OBJECTIVES: The present study aims to explore the role of FNAC in the diagnosis of various thyroid lesions presenting as solitary thyroid nodules (excluding multiple nodular lesion). MATERIAL & METHODS: 140 patients of more than or equal to 15 years of age presenting with solitary thyroid nodule were the subjects of the current study. Subjects were referred for fine needle aspiration by the treating clinicians. OBSERVATIONS: Male: Female ratio was (18/122) 1:6.8 and age of the patients ranged from 15 years to 62 years. Maximum number of cases was in 3 rd and 4 th decades. 4 patients were in 7 th decade. Cytodiagnostic break up of all 122 cases included colloid goitre 31 cases (25.5%), hyperplastic nodule 3 cases (2.5%), lymphocytic thyroiditis 2 cases (1.6%), Hashimoto's thyroiditis 7 cases (5.7%) and subacute thyroiditis 5 cases (4.0%), from non-neoplastic category. Amongst the neoplastic category, follicular neoplasm (45 cases, 36.9 %) was the most common lesion and remaining included 15 cases of papillary carcinoma (12.3%), 4 cases of Hurthle cell neoplasm (3.3%), 3 cases of medullary carcinoma (2.5%), 2 cases of anaplastic carcinoma (1.6%) and a solitary case of squamous cell carcinoma (0.8%). Colloid was observed in all cases and was abundant in 18 cases (58%) and moderate in 11 cases (35.5%). Dominant cellular pattern observed in all cases and uniform follicular cells were arranged in monolayered sheets (honey comb pattern), nuclear pleomorphism was an uncommon finding, being seen in only 4 cases (13%). Foamy histiocytes or hemosiderin laden histiocytes were a fairly common finding, being observed in 23 cases (74.1%). A cytodiagnosis of follicular neoplasm accounted for 36.9% (45 out of 122) of all diagnosis rendered on adequate aspirates and 64.3% of all diagnosed neoplasms. (45 out of 70 cases), thus reflecting that this entity comprised not only the highest number of cases amongst the neoplastic group but also the most common lesion when both non-neoplastic and neoplastic lesions were considered together. Aspirates from follicular neoplasms were either moderately cellular or highly cellular. Thus good cellularity was the outstanding characteristic feature observed in all cases. Blood in the background was a consistent finding observed in almost all the cases. Scant to moderate colloid was observed in 31 cases (68.8%). The dominant pattern was one of repetitive microfollicles or acini being observed in all 45 cases (100%). Most of the cases also had cellular aggregates with nuclear overlapping. Histopathological correlation was available in 20 cases. 19 cases were consistent with cytodiagnosis although 1 case showed discrepancy. CONCLUSION: It was concluded that FNAC of

Objectives: To evaluate the causes of puberty menorrhagia and effect of hormonal (Progestogens, estrogens and Combined Oral Contraceptive pills) and non-hormonal methods in the management of puberty menorrhagia.Methods: This prospective study included 51 subjects, who presented with puberty menorrhagia to Department of Obstetrics and Gynaecology, King George Medical University, Lucknow from August 2014 to August 2015. Assessment of each case with thorough history, physical examination and laboratory investigations was done. The underlying cause was diagnosed and the relevant treatment started and subjects kept under regular follow up.Results: In 26 (50.98%) subjects, immaturity of hypothalamic pituitary ovarian axis was the main cause of pubertymenorrhagia, 6 (11.76%) subjects had hypothroidism,5 (9.80%) subjects had polycystic ovarian syndrome, 4 (7.8%) subjects had idiopathic thrombocytopenic purpura, 2 (3.9%) subjects had disseminated intravascular coagulopathy, 3 (5.88%) subjects had hyperprolactinemia, 3 (5.88%) subjects had both hypothyroidism and hyperprolactinemia, 2(3.92%) subjects had fibroid uterus. All patients responded to medical management.Conclusion: Puberty menorrhagia is a distressing condition both for the subject as well as her parents. Most of thecases are due to anovulatory cycles which is a self-limiting condition at perimenarchal age group. Counseling and reassurance ofthe subjects is an important part of management. Long term medical treatment is successful in the majority of cases and rarely surgical intervention is required. Blood transfusion is required in a few cases.