Search

Purpose: To report clinical profiles of multiple sclerosis (MS)-associated uveitis in seven cases from a single tertiary eye care center in South India. Methods: Retrospective case series 2013-2023. Results: Seven cases of MS-associated uveitis were retrieved from our databases. There were five females and two males. The diagnosis of MS was made by the neurologist in all cases. Bilaterality was seen in all cases. Intermediate uveitis was the most common presentation (five cases). It was associated with peripheral retinal vasculitis (two cases) and disc pallor (two cases). Fuchs heterochromic iridocyclitis (one case) and incomplete Vogt-Koyanagi-Harada (VKH)-like presentation with a peripapillary choroidal neovascular membrane (one case) were the other presentations. In the case with incomplete VKH-like presentation, whole genome sequencing revealed a heterozygous non-synonymous variation (c.1228C>T) in exon 10 of TNFRSF1A, suggestive of susceptibility to multiple sclerosis 5 due to mutation in the TNFRS1A gene on chromosome 12p13.31. All cases received systemic steroids. Azathioprine (three cases) and rituximab (three cases) were the commonly used immunomodulatory drugs. The visual outcome was good in all cases at the last follow-up. Conclusion: MS-associated uveitis is underreported in India. This series highlights the clinical profile of MS-associated uveitis in India. [ABSTRACT FROM AUTHOR]

Background: Oral cancer encompasses all malignancies that originate in the oral tissues and remains a major public health problem throughout the world as an important case of poor health and illness. Head and neck cancer accounts for 9.8% of the estimated 6,44,600 incidental cancer cases in India. Oral Squamous Cell Carcinoma (SCC) is a serious and developing concern globally, accounting for more than 90% of malignant cancers of the oral cavity. Salivary diagnostics have been demonstrated to have potential in the detection and screening of oral pre-cancer and cancer in a variety of research settings. The continual and close contact between saliva and the mucosa, where cancer develops, is the foundation of this diagnostic capability. Materials and Methods: This research utilized spectrophotometry to quantify Lactate Dehydrogenase levels in serum and saliva of 30 healthy people which consisted the control group and 31 Oral Potentially Malignant people which constituted the study group. Results: On estimation and comparison, the mean Lactate Dehydrogenase levels in serum (397.4968+71.6392 IU/L) and saliva (675.4935+139.3352 IU/L) among patients with Oral Potentially malignant lesions/conditions were higher than the mean Lactate Dehydrogenase levels in serum (390.8667+71.0953 IU/L) and saliva (201.3700+89.1439 IU/L) among controls. Conclusion: Higher serum and salivary LDH levels in Oral Potentially malignant lesions/conditions than in control groups signifies the importance of assessing salivary LDH levels, in the prognosis of the same. Further prospective longitudinal studies are required to assess the salivary LDH levels among the patients with malignant transformation of Oral Potentially malignant lesions/conditions to oral cancers. [ABSTRACT FROM AUTHOR]

Context: At present, commonly encountered infections like urinary tract infections (UTIs) are becoming more and more difficult to treat. UTIs caused by extended‑spectrum β‑lactamase (ESBL) organisms tend to lead to uncertain outcomes and prolong hospitalization as these organisms are multidrug resistant. Such a situation has forced clinicians to reconsider the use of old antibiotics like fosfomycin. Aims: To determine fosfomycin susceptibility among ESBL‑producing Escherichia coli and Klebsiella pneumoniae isolates causing UTI in a tertiary care center in Western India. Settings and Design: This is a cross‑sectional study done in the Department of Microbiology between July 2021 and July 2022. Methods and Material: Urine samples from all outpatients and inpatients with suspected UTI which were received in the microbiology laboratory were inoculated in appropriate culture media. Pure growth of bacteria with a significant colony count was identified and antibiotic susceptibility testing was done as per standard guidelines. Statistical Analysis Used: The collected data were entered in a Microsoft Excel sheet and analyzed. Results: A total of 437 urine samples were collected from which 39 isolates of ESBL E. coli and 10 isolates of ESBL Klebsiella pneumoniae were obtained. All the E. coli isolates were sensitive to fosfomycin, while two of the Klebsiella pneumoniae isolates were resistant to fosfomycin. Conclusions: Older antibiotics like fosfomycin and nitrofurantoin attain high concentrations in the urinary tract, have a minimal impact on gastrointestinal flora, and do not develop resistance as compared to many other antibiotics. Therefore, fosfomycin should be preferred for the treatment of uncomplicated UTIs caused by resistant strains. [ABSTRACT FROM AUTHOR]

Background: Propofol is the drug of choice for procedural sedation. The addition of α2 agonist dexmedetomidine may improve the safety profile of the procedure by providing stable hemodynamics, better sedation quality, and decreasing the side effects of each drug during elective endoscopic retrograde cholangio-pancreaticography (ERCP). Materials and Methods: Eighty patients aged between 18 and 60 years were distributed randomly into two groups. The dexmedetomidine + propofol group (group DP) received an injection of dexmedetomidine at the dose of 1 mcg/kg in 100 mLsaline, and the propofol group (group P) received plain 100 mL normal saline over 10 min. Subsequently, both groups received a bolus dose of injection propofol 1 mg/kg as sedation, and a modified observer's assessment of alertness/sedation score (MOASS) score was assessed, followed by infusion at the rate of 50 mcg/kg/min during the procedure. A rescue bolus dose (20 mg) of propofol was administered when the patient showed signs of inadequate sedation or analgesia in both groups. Cardiovascular and respiratory parameters were recorded every 10 min throughout the procedure. Post-procedure modified Aldrete score was evaluated for 30 min, and the endoscopist's score was noted at the end of the procedure. Results: There was a significant difference (P = 0.001) in the additional number of rescue doses of propofol administered in group DP (3.47 ± 0.77) as compared to group P (8.78 ± 1.11). The total dose of propofol was lower in group DP (316.59 ± 43.29 mg) than in group P (443 ± 41.1 mg) with P value = 0.001. Statistically significant differences in the hemodynamic values were observed in group DP during infusion (P value < 0.05) of dexmedetomidine and throughout the procedure (P < 0.05) when compared with group P. Endoscopists graded the satisfaction score as very high (3.477 ± 0.77) in group DP. Conclusion: The addition of dexmedetomidine to propofol during ERCP provided better and safer sedation. [ABSTRACT FROM AUTHOR]

Background: Social and community participation are major indicators to assess the adequacy of treatment and rehabilitation in patients with spinal cord injury (SCI). This study examined the relationship between functional independence, level of disability, and social and community participation among people with SCI in India. Materials and Method: In this cross sectional study, 110 persons with SCI, aged 18 years and above participated in a community setting, in Karnataka, India. Spinal Cord Independence Measure Version III-self-reporting (SCIM III-SR), Craig Handicap Assessment and Reporting Technique (CHART), and WHO Disability Assessment Schedule 2.0 (WHODAS) were the clinical outcome measures. Spearman's correlation and stepwise multiple linear regression were done to determine association and identify the factors determining the community participation of people with SCI. Results: CHART physical independence had a positive correlation with SCIM self-care (R = 0.446) and SCIM mobility (r = 0.434). CHART cognitive independence (R = -0.38) and CHART mobility (R = -0.396) had a weak correlation with WHODAS. SCIM self-care and SCIM mobility (R² = 0.34) were determinants of CHART cognitive independence. SCIM respiratory and sphincter management and SCIM self-care (R² = 0.327) were determinants of CHART mobility. Conclusion: Self-care and mobility of people with SCI determine their ability to successfully reintegrate into the community, warranting a comprehensive community rehabilitation program. [ABSTRACT FROM AUTHOR]

Background: Plants are extremely useful to humankind as medicine, and hence the properties of medicinal plants have to be scientifically evaluated. Aim: The aim of this study is to establish pharmacognostical and phytochemical parameters for stem bark of Ximenia americana Linn. (Olacaceae). Materials and Methods: Macroscopical, microscopical evaluation, powder microscopical studies, quantitative microscopy, physicochemical evaluation, fluorescence analysis, analysis of inorganic elements, and determination of heavy metal contamination were performed as per the World Health Organization guidelines and standard methods. To evaluate various phytoconstituents, phytochemical investigations such as preliminary phytochemical screening, high-performance thin-layer chromatography, and high-performance liquid chromatography were performed. Results: Microscopical studies showed the presence of thick cortex, periderm cells, phloem parenchyma, phloem fibers, sieve elements, prismatic and granular calcium oxalate crystals, and resinous cells. The length and width of fibers, stone cells, and diameter of starch grains were measured. Physicochemical evaluation like ash values has shown total ash - 8.01% ± 0.02% w/w, acid-insoluble ash - 1.53% ± 0.02% w/w, water-soluble ash - 1.54% ± 0.01% w/w, sulfated ash - 12.02% ± 0.07% w/w, water-soluble hot extraction - 26.48 ± 0.02% w/w, cold maceration - 11.76% ± 0.04% w/w, alcohol soluble - 15.69% ± 0.03%w/w, ether soluble - 2.06% ± 0.03% w/w, and loss on drying - 4.88% ± 0.01% w/w. Conclusion: Pharmacognostical study on the stem bark of Ximenia americana may be reported as first. The results of pharmacognostical and phytochemical studies will be helpful for authentication and provide quality control parameters for the stem bark of this plant. [ABSTRACT FROM AUTHOR]

Background and Objective: Regional analgesia is effective for post-thoracotomy pain. The primary objective of the study is to compare the intraoperative requirement of isoflurane and fentanyl between general anaesthesia (GA) with epidural analgesia and GA with paravertebral analgesia. Methods and Material: A prospective observational comparative study was conducted on 56 patients undergoing open thoracotomy procedures. The patients were divided into two groups of 28 by assigning the study participants alternatively to each group: Group GAE received thoracic epidural catheterization with GA, and Group GAP - received ultrasound guided thoracic paravertebral catheterization on the operative side with GA. Intraoperative requirement of isoflurane, fentanyl, postoperative analgesia, stress response, need of rescue analgesics and adverse effects were observed and analysed. Results: 25 patients in each group were included in the data analysis. The intraoperative requirement of isoflurane (32.28 ± 1.88 vs 48.31 ± 4.34 ml; p < 0.0001) and fentanyl (128.87 ± 25.12 vs 157 ± 30.92 µg; p = 0.0009) were significantly less in the GAE group than in the GAP group. VAS scores and need of rescue analgesics and blood glucose levels were not statistically significant during the postoperative period (p > 0.05). The incidence of adverse effects was comparable except for hypotension and urinary retention which were significantly higher in the GAE group. Conclusion: GA with epidural analgesia resulted in significant reduction in the intraoperative consumption of isoflurane and fentanyl in comparison to GA with paravertebral analgesia. However, both the techniques were equally effective in the postoperative period. [ABSTRACT FROM AUTHOR]

Aortic valve (AV) repair is the desired surgical treatment option for young patients with aortic regurgitation (AR). It is considered as a class I indication for the surgical treatment of severeAR. The success of an AV repair depends on the detailed intraoperative transesophageal echocardiographic (TEE) examination which should fulfil the information required by the surgeon. The objective of this echo round is to describe the role of intraoperative TEE in systematic evaluation of the AV, before and after repair. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose of this study was to evaluate and estimate the knowledge, attitude, and practices of Indian fresh medical graduates with respect to ophthalmic emergencies. MATERIALS AND METHODS: This cross-sectional study was conducted on 1300 participants who had completed compulsory rotatory residential internship with the help of a questionnaire distributed through social platforms. The Chi-square and Pearson's coefficient relation tests were used. Statistical analysis was done using IBM SPSS. P <0.05 was taken as the level of statistical significance. RESULTS: Good knowledge proportionately corresponded to a good attitude with statistical significance (P = 0.000). Participants with good practice also had a good attitude with significance (P = 0.001). Good knowledge participants who managed ophthalmic emergencies were statistically significant than that of participants with poor knowledge and managed ophthalmic emergencies, 15.72%. (Χ2 = 16.653, P = 0.000). Attitude toward confidence in the management of ophthalmic emergencies and their willingness in undergoing training was significant (Χ2 = 43.8, P = 0.000). CONCLUSION: Educating and training fresh medical graduates can help in the management and mitigation of ophthalmic emergencies to reduce ocular morbidity and prevent blindness to a greater degree. [ABSTRACT FROM AUTHOR]

Introduction: Sepsis is a life-threatening condition with a very narrow golden period in which confirmatory diagnosis may change the outcome dramatically. No confirmatory biomarker is available till date for early diagnosis of sepsis. This study aimed to evaluate the combined and independent role of quick sequential organ failure assessment (qSOFA) score, lactate, and neutrophil–lymphocyte ratio (NLR) in diagnosis and mortality prediction in early sepsis. Methods: This was a hospital-based, single-center, prospective cohort study conducted in a tertiary care institute, Karnataka, India. Three hundred adult sepsis patients were recruited during 10-month period, and demographic data, qSOFA score, lactate, NLR, and culture samples were collected in ED within 1 h of admission. Outcome groups (survivor and nonsurvivor) were statistically analyzed with relative frequencies (%), median, mean ± standard deviation with 95% confidence interval (CI), univariate, bivariate, and multivariate logistic regression analysis, and Receiver -operating characteristic curve (ROC) curve to test the predictive ability of initial levels of three biomarkers. Results: Sepsis was more prevalent among middle-aged male patients. Male gender (odds ratio [OR], 6.9; 95% CI: 1.61–30.1), qSOFA (OR, 154; 95% CI: 15–1565), and lactate (OR, 1.36; 95% CI: 22–833) show 97% (area under the curve) predictive accuracy of the model for sepsis on bivariate and multivariate logistic regression analysis. A significant rise in NLR was a poor outcome indicator on univariate analysis (P = 0.773). Conclusion: All three biomarkers are good outcome predictors whereas qSOFA and lactate have diagnostic significance in early sepsis. These markers can be used for patient triaging, minimizing culture report dependence for treatment and ultimately the outcome. [ABSTRACT FROM AUTHOR]

Background: Normally, branches of superior mesenteric and inferior mesenteric arteries (IMA) supply the parts of intestine derived from midgut and hindgut and their variations are uncommon. One of the rarest variations is the presence of a middle mesenteric artery (MMA), an anomalous ventral branch of abdominal aorta originating in between the origins of superior and IMA supplying variable portions of the colon, sporadically reported mainly as case reports. Materials and Methods: While retrospectively examining multi-detector computed tomography angiographic abdominal scans of 500 subjects for analyzing the variations of branches of abdominal aorta, an anomalous artery supplying variable parts of colon was observed in one male patient. Observations: We report here an incidentally detected presence of MMA supplying large portions of colon in a male patient with nonrotation of gut, cholelithiasis, and portal hypertension. Computed tomography angiography of this patient also revealed variant celiac artery branching with hepatosplenic trunk and direct aortic origin of left gastric artery. Thus, there were five ventral branches of abdominal aorta supplying the gut which is a very rare presentation. Hepatic flexure of the colon was present between diaphragm and right lobe of the liver (Chilaiditi syndrome). Discussion and Conclusion: Our literature search has yielded 26 such cases reported globally, and to the best of our knowledge, this is the first report from India. Associated anomalies reported include abdominal aortic aneurysm, nonrotation of gut, and presence of other vascular anomalies. Failure to identify such an anomalous artery may result in its damage with subsequent bowel ischemia and other complications during surgery. [ABSTRACT FROM AUTHOR]

This research aimed to examine the association of job engagement among dental faculties in Kerala with certain sociodemographic and job-related factors. Job engagement levels were assessed using the Utrecht Work Engagement Scale, and comparisons were performed using the Mann–Whitney U-test and Kruskal–Wallis test. The findings revealed significant differences in job engagement based on the type of college, level of autonomy, and provision for time-bound cadre promotions. It also provided insights into the nonsignificant effects of gender, age, experience, and income on job engagement. The study contributes to the existing literature on employee engagement and provides valuable insights for organizations aiming to improve employee productivity and overall performance. Future research can build upon these findings to explore additional factors influencing job engagement and expand the understanding of work engagement in different contexts. [ABSTRACT FROM AUTHOR]

Context: While visco-supplementation is being used for the treatment of knee osteoarthritis (OA), the published reports vary widely in benefits afforded by this treatment. It was therefore proposed to assess the objective parameters along with subjective outcomes. Aims: Our study assessed the radiological and clinical efficacy of single-dose high-molecular-weight intra-articular hyaluronic acid (HMW-IAHA) injection in knee OA. Settings and Design: This interventional cohort study was conducted in a calculated sample size of 44 patients with knee OA. Materials and Methods: Visual analog scale (VAS) and knee OA and outcome score (KOOS) were used for clinical assessment, and whole organ magnetic resonance imaging score (WORMS) for radiological assessment. The subjects were given a single dose of HMW-IAHA injection, 90 mg/3 ml, and were assessed on day 0 and day 90. Statistical Analysis: Statistical Package for Social Sciences (SPSS) software was used. Results: At the day 90 follow-up, there was an improvement in mean ± standard deviation values of VAS score (day 0: 8.53 ± 0.81, day 90: 5.97 ± 0.87), KOOS score (day 0: 27.33 ± 15.18, day 90: 57.26 ± 14.26), and the cartilage signal and morphology in the medial femorotibial joint (day 0: 11.02 ± 6.26 and day 90: 10.91 ± 6.22) and patellofemoral joint (day 0: 10.35 ± 4.36 and day 90: 10.28 ± 4.39) compartments. There was a decrease in synovitis score from 2.3 ± 1.61 to 1.3 ± 1.3 in the medial femorotibial joint compartment and total WORMS score (day 0: 66.57 ± 36.06, day 90: 65.14 ± 35.62). Conclusions: A single dose of intra-articular injection with high-molecular-weight hyaluronic acid produces improvement in the clinical symptoms and quality of life as well as is effective in maintaining the articular cartilage integrity and reducing synovial inflammation. [ABSTRACT FROM AUTHOR]

Background: In the two decades from 1995 to 2018, approximately 48 farmers committed suicide every day, accounting for over 0.4 million deaths. Despite farmer's mental health being a priority, studies on farmers' mental health in general and depressive disorders in particular are limited. Aim: This study was conducted to find out the prevalence and factors associated with depressive disorders among farmers in Andhra Pradesh. Materials and Methods: We conducted a cross-sectional survey among a random sample of 360 farmers. Depressive disorders were measured using the Patient Health Questionnaire (PHQ)-9. Mild-to-moderate depressive disorders were the outcome variable. Factors associated with depressive disorders were identified using binary logistic regression. Results: The overall prevalence of depressive disorders was 22.2% (95% CI = 18.0%-26.9%). Female farmers (AOR = 4.16; 95% CI = 1.19-14.57), farmers aged ≥57 years (AOR = 4.90; 95% CI = 1.44-16.63), and single farmers (AOR = 4.96; 95% CI = 2.08-11.80) have greater odds of having depressive disorders. Conclusion: Efforts are required to address depressive disorders among farmers focusing on females, older farmers, and households reporting hospitalization. Since depressive disorders are closely associated with suicide attempts, these efforts are essential to avoid suicides resulting from depressive disorders. [ABSTRACT FROM AUTHOR]

Kikuchi-Fujimoto disease (KFD) or histiocytic necrotizing lymphadenitis is a benign, idiopathic, self-limiting, and systemic disorder involving lymph nodes (LNs) of unknown etiology. The first case was reported in Japan, with an increasing incidence globally. The disease is a challenge because of the nonspecific clinical features, and the disease is easily mistaken for other forms of lymphadenitis leading to misdiagnosis and mistreatment. It is associated with many autoimmune disorders, of which systemic lupus erythematosus (SLE) is the most common association. The diagnosis is based on the histological examination of LNs, which typically reveals necrosis surrounded by histiocytes with crescentic nucleus, immunoblasts and plasma cells, and absence of neutrophils. We report the case of a 24-year-old pregnant Indian female patient without any relevant past medical history to demonstrate the correlation between KFD and SLE complicated with autoimmune hemolytic anemia. [ABSTRACT FROM AUTHOR]

Background and Aims: In this cost-effectiveness model, we compared the cost-effectiveness of commonly used urinary biomarkers with conventional diuretic renogram (DR) in diagnosing ureteropelvic junction obstruction (UPJO). We hypothesized that urinary biomarkers are as effective as DR. Methods: We used incremental cost-effectiveness ratio (ICER) as a tool for our cost-effectiveness analysis model. The cost of biomarker assay and renogram were sourced from the same center while the accuracy data of DR and urinary biomarkers from the relevant pubications. Results: As the accuracy of individual biomarker increased, the ICER also got better. As a panel of biomarker was introduced, the ICER went to the negative range suggesting cost saving as well. ICER of most urine biomarkers is currently less expensive and less effective. When a biomarker panel was applied ICER became more expensive and effective. With higher samples, test running cost is likely to go down in future and thus biomarkers are likely become less expensive and more effective. Conclusions: Individual urine biomarkers are currently less expensive and less effective compared to DR in predicting UPJO. In future, biomarker panel is likely to be more cost-effective and reduce the need for invasive renogram thus reducing the radiation exposure. [ABSTRACT FROM AUTHOR]

In India, brucellosis is an often neglected zoonotic disease. Consumption of unpasteurized milk causes transmission of this infection to humans. Brucellosis can affect any organ in the body including the brain. However, the diagnosis is often missed as the clinical presentation of neurobrucellosis is atypical and can be confused with other diseases such as tuberculosis and Lyme disease. Therefore, laboratory investigations are critical for the diagnosis of this infection. Drugs such as doxycycline, rifampicin, and ceftriaxone are useful in the treatment of neurobrucellosis as it penetrates well into the central nervous system (CNS). We report a case of a 45-year-old man presenting with meningitis caused by Brucella melitensis because of the relative rarity of the neurobrucellosis in India. [ABSTRACT FROM AUTHOR]

Purpose: To report the spectrum of posterior segment manifestations and visual outcomes in a large series of patients with systemic lupus erythematosus (SLE). Methods: Retrospective study at a tertiary referral eye center in south India between 2016 and 2022. Results: Charts of 109 patients diagnosed to have SLE were retrieved from our medical database. Only nine cases of SLE (8.25%) had posterior segment involvement. The male: female ratio was 1:8. The mean age was 28 years. Unilaterality was the most common presentation in eight cases (88.89%). Lupus nephritis was the most common systemic presentation in five cases (55.56%). Antiphospholipid antibodies (APLA) positivity was seen in two cases (22.22%). Ocular manifestations included microangiopathy (cotton wool spots) in one case, occlusive retinal vasculitis with cotton wool spots in four cases (five eyes), optic disc edema with combined venous and arterial occlusion (one case), central retinal vein occlusion with cotton wool spots and hemorrhages (one case), macular edema (four cases), posterior scleritis with optic disc edema and exudative retinal detachment in the posterior pole (one case), and tubercular choroidal granuloma (one case). Treatment included systemic steroids, hydroxychloroquine sulfate (HCQS), and immunosuppression in all cases, blood thinners in two cases, and laser photocoagulation in four cases. HCQS-related retinal toxicity was not seen in any of the 109 cases. Ocular manifestation was the initial presentation of SLE in one case. Visual outcome was poor in three cases. Conclusion: Presence of posterior segment findings in cases with SLE may suggest a severe systemic disease. Early detection and aggressive treatment result in better visual outcomes. Ophthalmologists could play a vital role in guiding systemic therapy. [ABSTRACT FROM AUTHOR]

Background: This study was planned to estimate the effect of lockdown on psychosomatic problems and sleep of children and their association with screen the time during the lockdown. Methods: A cross‑sectional study was conducted among 1–12‑year‑old children at a tertiary care hospital in South India. A pre‑validated questionnaire with 20 related questions was disseminated through pediatric OPD, telemedicine service, and social media to eligible parents. Results: A total of 278 children aged 1–12 years with a mean (SD) age of 6.92 (3.01) years were studied. Most under 5‑year‑oldchildren had screen time of ≤2 hours/day, whereas 58.16% of children between 5 and 12 years spent >4 hours/day (P < 0.000). A significant proportion of participants aged 5–12 years had vision problems (P = 0.019), whereas under 5‑year‑old children had significant associated behavioral changes (P = 0.016) and sleep problems (P = 0.043). Conclusion: Behavioral and sleep problems were significantly high and correlated with an increase in screen time among under 5‑year‑old children. Vision problems were more in 5–12‑year‑old children. [ABSTRACT FROM AUTHOR]

Background and Objectives: Blood transfusion is the mainstay of treatment for several serious illnesses, surgical, and trauma patients. The aim of this study is to develop maximum surgical blood order schedule (MSBOS) for surgeries in our institute to formulate certain guidelines to prevent the over-ordering of blood and promote reasonable ordering of blood. Patients and Methods: All the patients undergoing surgeries in General Surgery, Surgical Gastroenterology, surgical oncology, Cardiovascular and Thoracic Surgery, Neurosurgery, Urology, and Orthopedics Departments requesting blood were included in this study. Cross-match-to-transfusion (CT) ratios, transfusion probability (TP), and transfusion index (TI) were calculated for individual specialties and surgeries. Based on these parameters, MSBOS was formulated. Results: During the study period, a total of 2724 patients posted for elective surgical procedures necessitating blood among various surgical departments were included in the study. A total of 5812 units of packed red blood cells were requested and cross-matched for the study population. Among these, 1831 units were transfused with a blood utilization percentage of 31.50% (6%-60%). The overall CT ratio of our study was 4.21. The overall TP was 31.69% and the overall TI was 0.56. Conclusion: Implementation of MSBOS is helpful in achieving the goal of rational usage of blood. Based on the results, we grouped the surgical procedures which need type and screen, type and hold, and type and cross-match. [ABSTRACT FROM AUTHOR]

This article discusses a case study of a 13-year-old male child who developed aortic root abscess after undergoing aortic valve repair surgery. The abscess was detected through imaging techniques such as transthoracic echocardiography and contrast computed tomography. The patient's surgical plan was changed to aortic homograft replacement based on the imaging findings. The article emphasizes the importance of multimodal imaging and echocardiography in the diagnosis and management of aortic root abscess. It also highlights the potential complications associated with this condition and the need for careful surgical planning. [Extracted from the article]

Context: Chromosomal abnormalities play an important role in diagnosis and prognosis of hematological diseases. Aims: The aim of the present study was to study the pattern and frequency of chromosomal aberrations in acute myeloid leukemia (AML) subgroups from western India. Settings and Design: A retrospective study was conducted through evaluating laboratory proforma which were filled during 2005 to 2014 for diagnosis and treatment of AML subjects. Methods and Material: We have studied chromosomal aberrations in 282 subjects with AML from western India. AML patients were sub‑grouped according to FAB classification. Cytogenetic study using conventional cytogenetics (GTG‑banding) and Fluorescence in situ hybridization (FISH) was carried out using FISH probes (AML1/ETO, PML/RARA, CBFB). Statistical analysis: Student’s t test for continuous variables and Pearson’s Chi‑squared test for categorical variables were used to identify the relationship between variables. Results: Cytomorphological study revealed AML‑ M3 as most frequent (32.3%) group followed by AML‑M2 (25.2%) and AML‑M4 (19.9%). Chromosomal abnormalities were identified in 145 (51.42%) of the total AML cases. A high frequency (38.6%) of chromosomal abnormalities was identified in AML‑M3 subgroup as compared to AML‑M2 (31%) and AML‑M4 (20.6%). Conclusions: Cytogenetic study is important for the diagnosis and management of the AML patients. Our study identified chromosomal abnormalities in AML subgroups with varied frequencies. It is important in diagnosis and monitoring of the disease. As younger AML patients were more affected in our study, etiological factors such as environmental factors need to be studied. Combination of conventional cytogenetics and FISH has an advantage of identifying high frequency of chromosomal aberrations in AML patients. [ABSTRACT FROM AUTHOR]

Background: There are only very few studies on estimating the prevalence of mild cognitive impairment (MCI) from India, particularly from a rural setting. The available studies were heterogeneous. Objective: The study estimated the prevalence of MCI in a rural setting in Kerala, India. Materials and Methods: We conducted a community‑based, cross‑sectional study among individuals aged 65 and above in rural Thiruvananthapuram, Kerala. A cluster‑randomized sampling was adopted, the cluster being the wards in the village. It was a two‑phase door‑to‑door survey. Grassroots‑level health workers enrolled 366 elders in the selected four wards in the initial phase and collected information on the sociodemographic details, comorbidities, and other risk factors of the participants, using a semi‑structured questionnaire. Additionally, the Everyday Abilities Scale for India (EASI) was administered to assess their activities of daily living. In the second phase, a neurologist and a psychologist examined those screened positive with EASI and diagnosed MCI and dementia based on the MCI Working Group of the European Consortium on Alzheimer’s Disease and the DSM V criteria, respectively. Results: The prevalence of MCI and dementia was 18.6% (95% confidence interval [CI] 14.7%–23.4%) and 6.8% (4.46%–10.1%), respectively, among the study participants. The prevalence of MCI was higher among the unemployed and those above 70 years of age. Conclusion: The community prevalence of MCI is more than three times that of dementia among the elderly in rural Kerala. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to assess and compare the changes in peripapillary retinal nerve fiber layer (RNFL) thickness in nondiabetics and diabetics with various stages of diabetic retinopathy (DR). Methods: The study subjects were divided into four groups based on their diabetic status and findings, namely, controls (normal subjects without diabetes [NDM]), diabetics without retinopathy (NDR), nonproliferative DR (NPDR), and proliferative DR (PDR). Peripapillary RNFL thickness was assessed using optical coherence tomography. One-way analysis of variance (ANOVA) with the post-Tukey HSD test was done to compare RNFL thickness in different groups. The Pearson coefficient was used to determine the correlation. Results: There was statistically significant difference in measured average RNFL (F = 14.8000, P < 0.05), superior RNFL (F = 11.7768, P < 0.05), inferior RNFL (F = 12.9639, P < 0.05), nasal RNFL (F = 12.2134, P < 0.05), and temporal RNFL (F = 4.2668, P < 0.05) across the different study groups. Pairwise comparison showed that there was a statistically significant difference in RNFL measured (average and all quadrants) in patients with DR (NPDR and PDR) and the NDM control group (P < 0.05). In diabetics without retinopathy, the RNFL measured was reduced compared to controls, but it was statistically significant only in the superior quadrant (P < 0.05). Average RNFL and RNFL in all quadrants showed a small negative correlation with the severity of DR and it was statistically significant (P < 0.001). Conclusion: In our study, peripapillary RNFL thickness was reduced in diabetic retinopathy compared to normal controls and the thinning increased with the severity of DR. This was evident in the superior quadrant even before the fundus signs of DR set in. [ABSTRACT FROM AUTHOR]

The effects of diabetes mellitus (DM) Type 2 and periodontitis have been studied for several years. In this review, the bidirectional effects on both these chronic inflammatory diseases have been evaluated. Both the diseases are known to exacerbate the pathophysiology of each other and reduce the quality of life of individuals suffering from these conditions with added risk factors. Increased blood sugar levels act adversely on dental plaque and the immune system causing inflammation leading to periodontitis and bone loss which in turn affects insulin sensitivity. Identifying and treating one of these conditions will help in reducing the severity of the other. Literature search was performed from electronic databases through PubMed and Scopus of articles published since 1996-April 2022. We included the research studies toward studies relating to the importance of collaborative approach in the management of periodontal conditions in subjects with Type 2 DM as a major criterion among population globally. This article shows the significance of why dentists and physicians should collaborate with each other for managing the periodontal and diabetic conditions of the patients. Both the diseases can be immensely improved if the providers are knowledgeable about the concept and a team approach is utilized. [ABSTRACT FROM AUTHOR]

Background: Myositis‑specific autoantibodies (MSA) and myositis‑associated autoantibodies (MAA) are clinically useful biomarkers that point to the diagnosis, clinical manifestations, and prognosis of dermatomyositis (DM). Materials and Methods: To estimate the prevalence of MSA as well as MAA and analyze possible clinical correlations of these autoantibodies in patients diagnosed with DM, we conducted a cross‑sectional study of 30 patients who were diagnosed with DM. Results: MSA were positive in 19 patients (63%) in which Mi 2 was positive in 8 (27%) patients, and this was the most frequently found MSA. A total of 11 (36.7%) patients showed positive MAA. AntiPM/Scl 75 and anti‑Ro 52 were positive in 5 (16.7%) patients each and these were the most commonly found MAA. Anti‑La was absent in all our patients. There were 8 (27%) patients in whom both MSA and MAA were positive. Either MSA and/or MAA were positive in 22 (73%) patients. On a bivariate analysis, the patients who were positive for anti‑PM/Scl 75 showed a significant difference in manifesting cutaneous ulcers (P value 0.023). It was also found that anti‑SAE‑positive patients showed a significant difference with malignancy (P value 0.014). Anti‑Ro 52‑positive patients were less likely to have symmetrical proximal muscle weakness (P value 0.006). Conclusions: All patients who were anti‑MDA 5 positive had myositis and none of the anti‑MDA 5‑positive patients had rapidly progressive interstitial lung disease (RPILD). More than one MSA in the same patient was noted in three patients. [ABSTRACT FROM AUTHOR]

Introduction: Treating primary hypothyroidism with appropriate weight-based dosing is usually straightforward. When supraphysiologic doses of thyroxine are required, it is important to know the reason behind the increased requirement. When compliance with medication is assured and when there are no drug interactions resulting in increased thyroxine requirements, a levothyroxine absorption test (LT4AT) could be performed to diagnose the coexistence of malabsorption. Materials and Methods: This was a single-center, retrospective chart review. Patients who had undergone LT4AT between 2018 and 2020 with a complete evaluation and follow-up records were reviewed. LT4AT and further evaluation (if necessary) were standardized, and details until the last review were obtained. Results: In all, 11 patients had complete records and follow-up details. The median age (range) of the cohort was 24 years (19 to 46), and the duration of hypothyroidism was 8 years (4 to 24). Seven had low absorption (<60%) in LT4AT of which two each had celiac disease and Helicobacter pylori infection; one had autoimmune gastritis, and in two the reasons of malabsorption was not known. The median follow-up duration was 13 months. Nine of 11 (81%) achieved euthyroid state with/without thyroxine dose reduction on follow-up. Conclusion: A high proportion of patients requiring supraphysiological doses of levothyroxine had occult malabsorptive states, some of which were curable. Even in those with pseudo-malabsorption, LT4AT helped in reinforcing compliance and thereby thyroxine dose reduction. [ABSTRACT FROM AUTHOR]

The goal of this Case report is to explain the treatment of generalized aggressive periodontitis in a Perio-implant continuum approach. A patient aged 24 years reported to the department of Periodontics with the chief complaint of missing in 31 and mobility irt 41 past 1 year. Based on clinical and radiographical findings, the case was diagnosed as generalized aggressive periodontitis. The patient was explained the prognosis and treatment plan. Blood investigations were normal, after which Phase 1 therapy was initiated followed by a surgical phase with full mouth flap surgery and extraction and placement of basal implants irt 31,41 and restored with cement-retained fixed prosthesis. The patient is kept under the maintenance phase. Six months follow up is done and healing was satisfactory. The above case report can be taken into consideration for fixed rehabilitation of missing teeth with basal implants in generalized aggressive periodontitis. [ABSTRACT FROM AUTHOR]

Stature is an essential measurement in anthropometry that resolves individual representation of the body. Forensic determination is the resolution of origin, sex, and natural height. Many previous study has been done on estimation of height using various measurements of teeth and skull. The aim of this study was to estimate stature from head circumference and to derive a linear regression formula between them. The study was conducted in Saveetha Dental College among 70 1st year students (35 males and 35 females). Stature was measured using a stadiometer and head circumference was measured using measuring tape. All the measurements were tabulated and linear regression equation was done using the SPSS software (version 23). For males, Y = 1.85x + 71.12, r = 0.487; for females, Y = 2.07x + 46.24, r = 0.433. By the study, we know that in both genders, head circumference has moderate correlation in estimating stature. From the present research, we conclude that head circumference is a moderately reliable parameter for stature estimation in both genders. [ABSTRACT FROM AUTHOR]

Background and Aims: Dysplastic nubbin also referred to as testicular regression syndrome (TRS) is found in 5% of cases of the Non palpable testis (NPT). There is no consensus on the excision of the above and fixation of the contralateral solitary testis. We aimed to survey the prevalent practice of the same among members of the Indian Association of Pediatric Surgeons (IAPS). Methods: A structured questionnaire was sent through group e-mail and social media platforms to IAPS members to identify their practices in management. Results: A total of 132 surgeons responded to the questionnaire. Excision of intra-abdominal and inguinoscrotal TRS remnants was practiced by 84% (95% confidence interval [CI] 77%–89%) and 82% (95% CI 74%–87%). Fixation of contralateral solitary testis was practiced by 62% (95% CI 53%–70%) in the above scenario. Among the respondents, 30% reported encountering torsion of solitary testis during their career and this experience was a significant factor (P = 0.01) in deciding contralateral orchidopexy. Scrotal infection/necrosis was not encountered by a majority (72%) and it was not a deterrent factor in preventing contralateral orchidopexy (P = 0.68). Conclusions: The majority of pediatric surgeons favored the removal of intra-abdominal/inguinoscrotal TRS remnants identified during laparoscopy for NPT. A majority favored sutureless fixation of the contralateral solitary testis. [ABSTRACT FROM AUTHOR]

Background: In India, the elderly (aged 60 and above) constitute 8.2% of the total population and are expected to increase to 10% by the year 2020. Globally, around 450 million people are suffering from diabetes mellitus. Frailty is regarded as a predisability state and, therefore, if identified early, may avert many adverse health outcomes in the elderly. Diabetes and frailty are found to be close associates. Materials and Methods: This community-based cross-sectional study was conducted among 104 elderlies with diabetes mellitus residing in an urban slum situated in Mysuru for a period of 6 months. Pretested structured questionnaire was used to collect the information on sociodemographic characteristics and details of diabetes. The Tilburg's Frailty Scale was used to assess frailty, and the Mini Nutritional Assessment Scale was used to assess the nutritional status. Results: The prevalence of frailty among the study population was 53.8%. 51% of the subjects were found to have their glycemic status under control, 16.3% were malnourished, and 70.2% were at risk of malnutrition (RMN). The majority of the subjects with malnourishment were frail (76.5%) followed by those at RMN, 36 (49.3%). Gender, marital status, engaging in occupation, socio economic status, poor glycemic control were found to be significantly associated with frailty. Conclusion: The prevalence of frailty is significantly higher among elderly diabetics. The poorer glycemic control is a significant factor associated with frailty, and malnourished elderlies are more at risk of developing frailty. [ABSTRACT FROM AUTHOR]

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affects kidneys mainly in the form of acute kidney injury but rarely can cause glomerular disease. On a very rare occasion, SARS-CoV-2 infection can be associated with anti-neutrophil cytoplasmic antigen (ANCA)-associated vasculitis and anti-glomerular basement membrane glomerulonephritis (anti-GBM GN). We report a case of a 59-year-old man who presented with progressive renal failure 8 weeks after contracting the viral infection, which progressed slowly to severe renal dysfunction. Renal biopsy showed crescentic glomerulonephritis (CrGN) accompanied by interrupted linear IgG deposits along the glomerular basement membrane (GBM) on immunofluorescence (IF) staining with associated mild acute tubular injury. The serology for anti-myeloperoxidase (MPO), as well as anti-GBM antibodies, was positive. He was treated with steroid and pulse intravenous cyclophosphamide, following which there was a significant improvement in the renal function and serological resolution of both the antibodies 6 months post-treatment. To the best of our knowledge, this is the first reported case of "double-antibody" positive CrGN following SARS-CoV-2 infection. [ABSTRACT FROM AUTHOR]

COVID-19 is a novel coronavirus infection that can cause a severe respiratory illness and has been declared a pandemic by the WHO. Compared with adults, most pediatric patients with COVID-19 are mostly asymptomatic, whereas others show distinctive characteristics in clinical presentation and imaging. Most of the pulmonary lesions were ambiguous on chest radiographs. The routine use of computer tomography of chest in the evaluation of children with suspected or confirmed COVID-19 is useful in diagnosing and monitoring pediatric COVID-19 pneumonia. Clinicians and radiologists should become familiar with the computed tomography findings of COVID-19, as the early detection of lesions by computed tomography is conducive to reasonable management and early treatment for pediatric patients. This minireview examines the most recent evidence to recommend usage of chest imaging modalities in children with COVID-19. [ABSTRACT FROM AUTHOR]

Flexible bronchoscopy (FB) is a frequently employed diagnostic procedure for evaluating respiratory disorders.[[1]],[[2]] Studies in the previous decades suggest a complication rate of 1% with FB.[[3]],[[4]] The complication rates in the contemporary era are unknown. We reviewed our bronchoscopy database to assess the frequency of major complications among subjects undergoing FB procedures without sedation. [Extracted from the article]

Background: Approximately 5% of COVID-19 patients suffer from near-fatal disease. Clinical and radiologic features may predict severe disease although with limited specificity and radiation hazard. Laboratory biomarkers are specific, simple, and point-of-care triage tools that can be used to predict the severity of the disease. This research aimed to study the role of inflammatory markers (serum ferritin, lactate dehydrogenase [LDH], D-dimer, and C-reactive protein [CRP]) in prognosticating COVID-19 patients. Methodology: This was a hospital-based retrospective study conducted on COVID-19 adult inpatients classified into three groups: mild disease-recovered (Group I), severe disease-recovered (Group II), and dead (Group III). Categorical outcomes were compared using the Chi-square test. Univariate binary logistic regression analysis was performed to test the association between the outcome and explanatory variables. An unadjusted odds ratio (OR) along with a 95% confidence interval was calculated. The utility of laboratory parameters (ferritin, LDH, neutrophil/lymphocyte ratio, D-dimer, and platelet/lymphocyte ratio) in predicting the severity of COVID-19 was assessed by the receiver operative curve analysis. P < 0.05 was considered statistically significant. Results: A total of 500 case records were analyzed. The mean age was 49.32 ± 17.1 years. About 72.4% were <60 years and 301 male and 199 female patients were included. The comorbidity count included diabetes mellitus 168 (33.6%), hypertension 122 (24.4%), coronary artery disease 23 (4.6%), hypothyroidism 3 (6%), and others 33 (6.6%) The median levels of ferritin among the three groups differed significantly bearing higher levels in Group3 (P<0.001). Median LDH and D-dimer values of the three groups showed statistical significance (P<0.001). Qualitative CRP was significantly associated with poor outcomes (P < 0.001). The odds of patients suffering severe COVID-19 rose with rising values of ferritin, LDH, and D-dimer (unadjusted OR: 1.007, 1.004, and 1.020). Conclusion: Onetime measurement of serum ferritin, LDH, D-dimer, and CRP performed between 7th and 10th day of symptoms significantly predicted outcomes for COVID-19 inpatients. [ABSTRACT FROM AUTHOR]

Background: Dermatosis neglecta (DN) is an underdiagnosed localized pigmentary disorder, characterized by asymptomatic hyperpigmented patches and plaques with adherent scales in an inadequately cleansed area. It is a diagnostic challenge leading to unnecessary interventions and burden to patients. Dermoscopy is a noninvasive handy diagnostic tool, though its utility in the diagnosis of DN is unexplored. Objective: To describe the various clinical and dermoscopic patterns in patients with DN. Materials and Methods: An observational study in 10 admitted patients of a tertiary hospital with DN was done, who consulted in department of dermatology in view of hyperpigmented lesions. After a thorough history and clinical examination, dermoscopy was done over the lesions. Results: In 10 patients, DN was confirmed with a resolution of part of lesion on the application of water-soaked gauze. On dermoscopy, dark-brown polygonal, cornflake-like scales are seen arranged in a mosaic pattern with intervening normal skin, sometimes over an erythematous background. On further probing, most patients gave the history of unintentional neglect of the affected part related to their primary illness. Limitations: Small sample size. Conclusions: DN is an underreported localized hyperpigmented disorder, mimicking other dermatoses. It should always be kept in mind in patients with morbidities that lead to the inability to maintain hygiene in the relevant areas, which may not be the classically described sites of DN. Dermoscopy helps to differentiate it from other hyperpigmented lesions, especially in its milder forms, avoiding the act of wiping the lesions especially in areas associated with hyperesthesia and helps in reinforcing the diagnosis. However, the criteria to diagnose DN based on dermoscopy is not definite. [ABSTRACT FROM AUTHOR]

Mastitis has well-recognized harmful effects on dairy farm profitability. Furthermore, mastitis impairs the milk component synthesizing ability of secretary tissues. Various therapies are available for the treatment of clinical mastitis. Meloxicam exhibits preferential binding to Cyclooxygenase-2 (COX-2) receptor and consequently generates fewer negative gastrointestinal side effects than nonspecific COX inhibitors such as flunixin meglumine and ketoprofen. Toward this end, research efforts directed at understanding the use of meloxicam alone and in combination with other antibiotics to improve milk quality and production. Therefore, in this review, we have highlighted the mechanism, biopharmaceutical challenges, and merits of meloxicam usage in dairy cattle mastitis. In addition, we also presented the integration of artificial neural network, in silico docking, and nanotechnology-driven topical drug delivery cargo as future opportunity for efficient delivery of meloxicam in the management of clinical mastitis. [ABSTRACT FROM AUTHOR]

Introduction: Primary percutaneous coronary intervention (PPCI) represents a timely procedure that requires speedy revascularization. Moreover, PPCI in diffuse coronary lesions remains to be challenging even in the hands of experienced operators as the use of a long stent may increase the difficulty of the procedure in terms of stent delivery, deployment, and optimization. However, the practicability and clinical outcomes of deployment of a 60-mm-long stent in the setting of PPCI remain to be determined. Methods: The study is a retrospective observational analysis in a prospective cohort. The prospectively gathered data of consecutive patients from June 2016 to December 2019, who underwent PPCI with BioMime sirolimus-eluting stents 2.5-3.0/60 mm or 3.0-3.5/60 mm were analyzed at 1 year regarding the primary outcome of major adverse cardiovascular and cerebrovascular events (MACCE) and target lesion revascularization (TLR). Results: A total of 88 cases were included in the study; 23 cases underwent PPCI, whereas 65 underwent nonPPCI. The PPCI group had a mean age of 65.7 ± 10.9 years compared with 63.3 ± 9.6 years (P = 0.34) in the nonPPCI group. Eighty-three percentage of PPCI were males compared with 94% of their nonPPCI counterparts (P = 0.20). In addition, the prevalence of hypertension was more common in the PPCI group (87% vs. 63%, P = 0.03). There was no statistically significant difference between the two groups regarding other comorbidities. The most common culprit vessel was the left anterior descending artery (57%) in the PPCI group and the right coronary artery (58%) in the nonPPCI. The use of a stent with a diameter of 2.5-3.0 mm was more common in both groups (61% in PPCI vs. 66% in nonPPCI, P = 0.8). MACCE occurred in four patients during a year of follow-up. One occurred in the PPCI group (4%) compared with three in the nonPPCI group (5%) (P = 1.00). TLR was required in two cases, one in each group (4% vs. 2%, P = 0.46). Conclusion: The use of a 60-mm-long stent in the setting of PPCI has an excellent 12-month outcome in procedural success, MACCE, and TLR. Large randomized studies are required to confirm these results. [ABSTRACT FROM AUTHOR]

Background: The first case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified in Wuhan, China, in late 2019, the epicenter of the COVID-19 outbreak. In India on January 30, 2020 and in Andhra Pradesh on March 12, 2020 first case was reported. The case fatality rate (CFR) among diagnosed cases is generally about 2%-3% but varies by country. Aim: To estimate the CFR in Andhra Pradesh during the pandemic in different phases. Methods: All the secondary data were collected either from the covid19india website or github website or Indian government websites or Andhra Pradesh State government website or media quoting the government announcements January 30, 2020 to August 8, 2020. The CFR was estimated as per the Methods for Estimating the Case Fatality Ratio for a Novel, Emerging Infectious Disease. Results: In the pre-lockdown phase, the CFR of Andhra Pradesh was 0.00%, Uttarandhra, Central Andhra & Rayalaseema was Nil, and South Andhra it was ranging from Nil-0.00%, In lockdown phase, the CFR Andhra Pradesh was ranging from 1.34 to 42.31%, Uttarandhra - Nil -5.56%, Central Andhra - Nil-100.00%, South Andhra - 0.00-66.67%, and Rayalaseema - Nil-100.00%. In post-lockdown phase, the CFR Andhra Pradesh was ranging from 0.99 to 2.50%, Uttarandhra - 0.59 to 4.55%, Central Andhra - 0.82 to 14.33%, South Andhra - 1.05 to 2.30%, and Rayalaseema - 0.37-8.07%. Conclusions: The CFR of confirmed cases of COVID-19 in Andhra Pradesh and its districts was a downward trend except Prakasam district. [ABSTRACT FROM AUTHOR]

A 20-year-old woman presented with sudden vision loss in her left eye following a coughing episode. She was diagnosed with Valsalva retinopathy and underwent a YAG hyaloidotomy, but the hemorrhage only drained minimally. The next step was to perform pneumatic displacement, which involved injecting sulfur hexafluoride (SF6) and maintaining a prone position. After 14 days, the hemorrhage was completely absorbed and the patient's vision improved to 6/6. This case study highlights the successful use of pneumatic displacement in treating Valsalva retinopathy. [Extracted from the article]