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Background: Multidrug-resistant tuberculosis (MDR-TB) refers to tuberculosis that resists at least two primary drugs, namely isoniazid and rifampicin. To assess the management of MDR-TB, sputum culture conversion is performed. This study aimed to determine the culture conversion status of MDR-TB patients undergoing an all-oral longer regimen. Methods: This research constitutes an observational and prospective study conducted within a hospital setting. The study was done at the Department of Microbiology, IGIMS, Patna, from October 2020 to March 2022. Culture conversion in multidrug resistance pulmonary tuberculosis on all-oral longer regimens took one spot and one morning sample of sputum as per standard protocol after completing two months of all-oral longer regimens and culturing it in liquid broth using Mycobacterium Growth Indicator Tube (MGIT) 960 System at two, four then six months till we got a negative result. Results: Maximum number of the cases, 77 (74.8%), belonged to 19-35 years of age group. Males were 68 (66.1%) and females were 35 (33.9%), respectively, with male to female ratio of 1.9:1. After 2 months of oral longer regimen treatment, out of 103 cases, we found 98 (95.1%) patients had sputum for culture positive and only five (4.2%) patients had sputum for culture negative. After 6 months of oral longer regimen treatment, out of 101 cases, we found 16 (15.8%) patients had sputum for culture positive and 85 (85.2%) patients had sputum for culture negative. Conclusion: In patients with multidrug-resistant pulmonary tuberculosis (MDR-TB) who received an all-oral longer regimen, the introduction of bedaquiline led to positive outcomes as evidenced by a greater number of negative sputum cultures, a decrease in culture reversions, and a reduced risk of developing a more resistant form of MDR-TB. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to evaluate the location and radio morphometric features of the posterior superior alveolar artery (PSAA) in patients undergoing rehabilitation of posterior maxilla and other sinus augmentation surgical procedures by cone-beam computed tomography (CBCT). Materials and Methods: A total of 816 CBCT scans were included. Various radio morphometric measurements were done to assess the PSAA location, diameter, and distances to the sinus floor and alveolar crest. Results: The PSAA was mostly intraosseous in the maximum in the age group 31-51 years (56%), in males (53.4%), and in dentate patients (57.4%). The artery tends to be wider in older patients. Distances to the sinus floor or the alveolar crest tend to be shorter in women. Conclusions: This study suggests that CBCT is a valuable pre-surgical tool and the evaluation of the PSAA on CBCT images could reduce the likelihood of excess bleeding during surgery in the maxillary posterior region. [ABSTRACT FROM AUTHOR]

This article discusses a study that aimed to standardize and understand the pharmacokinetics and safety of a classical Ayurvedic formulation called Shadanga Paniya. The researchers conducted qualitative and quantitative estimations of alkaloids, flavonoids, and total phenolic contents in the formulation and its constituent herbs. The results showed the presence of flavonoids and total phenolic acid in the constituent herbs, while alkaloids were only found in one herb. This research provides valuable information for the development of new analytical protocols for the standardization of herbal/ayurvedic formulations. [Extracted from the article]

The whole world has battled with multiple waves of coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 virus. However, the second wave of COVID-19 had caused a worldwide havoc in terms of disease transmissibility, severity, and mortality. India has been among the worst hit countries during the second wave, which substantially overburdened and overwhelmed the Indian health care system. While secondary infections and co-infections among COVID-19 patients were increasingly being reported, COVID-19-associated mucormycosis (CAM) emerged as a new challenge particularly from India and became a matter of immediate concern. The most common causes attributed to the rise of CAM were undiagnosed/uncontrolled diabetes mellitus, excessive use of corticosteroids, and prolonged hospital stay, all of which create a perfect environment for mucormycosis infection to set in. [ABSTRACT FROM AUTHOR]

Lymph nodes, bones, lungs, liver, and the peritoneum are common sites for bladder cancer metastasis. Skeletal muscle involvement is rare. We report the case of a 55‑year‑old male who has a poorly differentiated carcinoma of the urinary bladder with multiple skeletal muscle metastases. [ABSTRACT FROM AUTHOR]

Background: Acne vulgaris is a chronic disease of pilosebaceous units that affects approximately 80% of adult population. Despite various treatment modalities being reported, treating acne with minimal side effects is difficult. Specifically, topical carbon suspension combined with QsNdYAG laser treatment (carbon peel laser technique) has gained popularity recently for effective treatment of acne vulgaris. Objectives: To study the efficacy of carbon peel laser technique in the management of acne vulgaris (Grade II-IV) in skin of color. Materials and Methods: A prospective observational study was done on 35 patients who presented with acne vulgaris Grade II-IV, who were poorly compliant to treatment with topical/systemic agents owing to side effects or failure of treatment, to meet patient's expectations. The patients were subjected to an initial topical application of carbon suspension (Cosderma Carbon gel) followed by treatment with quality switching neodymium yttrium aluminum garnet (Qs:NdYAG) laser in two modes (quasi long pulsed mode followed by Q switched mode 1064 nm). The treatment consisted of three sittings with intervals of 2 weeks. The patients were asked to avoid use of any topical/systemic medication for acne during this period. Results: Significant reduction of erythematous and nodular acne lesions was noted after three sittings of "carbon peel laser technique". Among 35 patients, 28 (80%) showed >80% improvement and 7 (20%) showed 50%-80% improvement in skin lesions in the form of decrease in the number and size of lesions and extent of inflammation, with no patients nonresponsive to treatment. The postprocedure complications were minimal; 6 (20%) developed erythema, and 1 (3.3%) patient developed mild tolerable pain with no post inflammatory hyper/hypopigmentation. The postprocedure mean ISGA (Investigator Status Global Assessment) was 1.342 as compared with preprocedure mean ISGA of 3.657 with value of P <0.0001. Conclusion: Carbon peel laser technique is an effective method for the management of acne vulgaris in skin of color with minimal side effects and significant results. [ABSTRACT FROM AUTHOR]

Introduction: Urinary bladder cancer is a major cause of morbidity and mortality worldwide. As per the data from the US cancer registry, it was diagnosed in nearly 71,000 patients and led to 14000 deaths in 2013. The Indian data in this regard are lacking with few case reports and epidemiological data only. The paucity of treatment data in this regard led us to undertake this prospective study at our radiation oncology canter. Carcinoma urinary bladder is a heterogeneous disease with variable natural history. Male preponderance and association with cigarette smoking appears to be the foremost in natural history of the disease. Our data analyzed the management of muscle-invasive medically and surgically inoperable carcinoma urinary bladder in a resource constraint setting at a tertiary care center by bladder preservation protocol (BPP). Materials and Methods: This prospective study was aimed to evaluate the treatment outcome in surgically inoperable muscle-invasive carcinoma urinary bladder in a resource constraint setting at a tertiary care center by BPP. All patients were treated with telecobalt 60 machine up to a dose of 60--66 Gy along with concurrent chemotherapy. Interim assessment was done at 40 Gy. Results: A total of nine patients were taken up for treatment with BPP. All patients were evaluated with standard evaluation protocol. All patients were followed up till any event occurred and till 6 years. Out of nine patients treated, six patients are still alive without any progression of disease and are disease free with standard evaluation on follow-up. Two patients died during the 1st year of follow-up. One patient progressed with lung and abdominal metastases 5 months after the completion of treatment and one patient was lost to follow-up. Conclusion: BPP using trimodality therapy is a suitable alternative to radical cystectomy in medically and surgically inoperable carcinoma urinary bladder. These patients should be highly compliant for regular follow-up, and acute and long-term toxicity should be evaluated in detail at each visit. BPP gives a ray of hope in such settings and should be done with caution. In our study, we treated all these patients in our resource constraint settings with good results and high survival rates. Our integrated team of radiation oncologists, medical oncologists, and urologists closely followed up these patients in order to optimize outcomes. [ABSTRACT FROM AUTHOR]

Context: Many studies have engrossed on correlating one or two biomechanical parameters related to the lower limb alignment factors but not many have taken into account the effect of increased body weight on the relationship between Q-angle and pelvic tilt. Aim: The present study aims to assess the changes in pelvic inclination angle (PIA) and quadriceps angle (Q-angle) in the different categories of body mass index (BMI). Furthermore, to find an association between PIA, Q-angle, and waist-hip ratio (WHR) in different categories of BMI. Setting and Design: The Observational case control study was conducted on community dwelling individuals from Delhi NCR. Subjects and Methods: Two hundred and forty participants (120 participants of BMI score 18.5-22.9 kg/m2 (normal weight healthy individuals) and 120 participants of BMI score >25 kg/m2 (obese healthy individuals) were recruited on the basis of inclusion and exclusion criteria. BMI, PIA, Q-angle, and WHR were assessed in the standing position. Statistical Analysis: Intra-class correlations of analysis was done using the Pearson correlation coefficient calculation for all the measured variables. Results: Significant higher mean values of PIA and Q-angle were observed in obese participants when compared with normal weight participants (P < 0.01). BMI was significantly positively correlated with PIA (P = 0.011) and Q-angle (P = 0.014) for obese population, whereas no significant association was found to normal weight healthy population. Similarly, statistically significant positive correlation was found between PIA and Q-angle (P < 0.01). Conclusion: The study concluded that increase in body weight is an important factor which influences the biomechanical alignment of kinematic chain segments of the lower quadrant of the body. Hence, it is very important to focus on proper biomechanical alignment and the whole lower extremity should be considered rather than a single segment as a factor, because one mechanical factor has the potential to compensate for or affected by another when functioning in the weight bearing position. [ABSTRACT FROM AUTHOR]

Crohn's disease may affect individuals across all age groups. Usually, it tends to start at a young age, hence late onset Crohn's disease may be difficult to diagnose. The incidence of late-onset inflammatory bowel disease in the United States is 4 to 8 per 100,000 per year. The incidence of Crohn's disease is more in the United States and Europe and less in Asia and Africa. This makes it more challenging to suspect Crohn's disease in an elderly individual of Indian origin. It may be confused with Irritable bowel syndrome or Intestinal tuberculosis. [ABSTRACT FROM AUTHOR]

Background: Urinary tract infection (UTI) is a common infection in children with nephrotic syndrome (NS). Clinical experience suggests that childhood nephrotic syndrome is frequently diagnosed incorrectly and managed inadequately on the top of this existing UTI in the episode becomes an additive obstacle for the primary care physicians or pediatricians towards optimum management, leading to poor outcome. So, we have conducted this clinico- microbiological study of UTI in NS in children to provide the exact picture of UTI with NS so that the primary care providers can be helped in having high index of suspicion of this infection and knowing prevalent organisms and their antimicrobial sensitivity pattern. Aim: The aim of the study was to study clinical features and identify the responsible organisms with its drug sensitivity pattern with response to treatment in various types and stages of NS with UTI in children. Methods: This cross-sectional hospital based study was conducted on 50 children of 2-18 years of age with NS attending nephrology clinic or admitted to the Paediatric ward of AIIMS, Rishikesh. Demographic, clinical, and microbiological data were recorded and details were entered in a predesigned proforma sheet. Results: Out of 50 cases, 8 (16%) had a positive urine culture. Six (75%) out of them had first episode and two (25%) were frequent relapsers of NS. Fever, decreased urine output, and generalized edema were the presenting features. The most common bacteria responsible for UTI was Pseudomonas aeruginosa (in around 25% isolates). Escherichia coli and Citrobacter koseri were the most resistant organisms. Patients were treated with antibiotics according to sensitivity pattern which resulted in resolution of symptoms and repeat urine culture became sterile subsequently. Conclusion: About one-sixth of children with Nephrotic Syndrome had UTI. UTI should be ruled out in every case of NS in active phase to prevent long-term morbidity and mortality. [ABSTRACT FROM AUTHOR]

Introduction: Endoscopic retrograde cholangiopancreaticography (ERCP) is an essential therapeutic procedure with a significant risk of complications. Data regarding the complications and predictors of adverse outcomes such as mortality are scarce, especially from India and Asia. We aimed to look at the incidence and outcome of complications in ERCP patients. Materials and Methods: This study is a retrospective analysis of prospectively collected data of all the patients who underwent ERCP and had a complication from January 2012 to December 2018. Data were recorded in predesigned pro forma. The data analysis was done by appropriate statistical tests. Results: A total of 17,163 ERCP were done. A total of 570 patients (3.3%) had complications; perforation (n = 275, 1.6%) was most common followed by pancreatitis (n = 177, 1.03%) and bleeding (n = 60, 0.35%). The majorities of perforations were managed conservatively (n = 205, 74.5%), and 53 (19%) required surgery. Overall, 69 (0.4%) patients died. Of these, 30 (10.9%) patients died with perforation. Age (odds ratio [OR]: 1.04, 95% confidence interval [CI]: 1.005–1.07) and need of surgery (OR: 5.11, 95% CI: 1.66–15.77) were the predictors of mortality in patients with perforation. The majority pancreatitis were mild (n = 125, 70.6%) and overall mortality was 5.6% (n = 10). Conclusion: ERCP complications have been remained static over the years, with perforation and pancreatitis contributing the most. Most perforations can be managed conservatively with good clinical outcomes. [ABSTRACT FROM AUTHOR]

Insulinoma is a rare pancreatic neuroendocrine tumour (PNET) with an incidence rate of 4 per million population, and the most common cause of hypoglycaemia due to endogenous hyperinsulinism. We present the story of a 61-year-old male, who was extensively evaluated at many hospitals for his symptoms of giddiness, uneasiness and recurrent black outs for the last 3 months, his symptoms disappearing with a carbohydrate rich meal or sweets. Random sugar and fasting sugar values noted were low, with elevated insulin and C-peptide levels. Diagnosis of insulinoma was confirmed by a DOTA PET scan involving the tail of the pancreas and then surgically removed. Early detection is crucial for early surgery to allay symptoms. We describe our diagnostic and treatment plan with reference to previously published reports. [ABSTRACT FROM AUTHOR]

Scrub typhus is an acute febrile illness caused by the bacterium Orientia tsutsugamushi. It usually presents with high-grade fever, body aches, and skin rash. We report the case of a woman who presented with acute febrile illness, bilateral pneumonia, and severe hypoxemia. The presence of a typical eschar on the abdomen, made us suspect scrub typhus. Anti-O. tsutsugamushi Immunoglobulin M (IgM) antibody in the serum was detected in significant titers. She was treated with intravenous doxycycline and supplemental oxygen. Thus, scrub typhus should be considered in the differential diagnosis of febrile illness with acute respiratory distress syndrome. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy and safety of low dose insulin infusion (0.05 U/kg/h) against the standard dose insulin infusion (0.1 U/kg/h) in children with diabetic ketoacidosis. Method: Children (age <12 years, n = 30) presenting with diabetic ketoacidosis were enrolled and randomised to receive insulin infusion either as 0.05 U/kg/h (low dose) or 0.1 U/kg/h (standard dose) as an open labelled randomised controlled trial. The rest of the management was identical in both groups. The time taken for resolution of acidosis (pH =7.3 and HCO3 =15) was the primary outcome variable. The secondary outcome variables included the time taken until a decline in blood glucose to 250 mg/dl, the proportion of children developing hypoglycemia and hypokalemia, and any treatment failure. Results: The two groups were similar with respect to mean age, weight and gender distribution. New-onset diabetes was diagnosed on 24/30. The mean ± SD time for resolution of acidosis was similar between the groups; 27.0 ± 6.1 hours in the low dose group vs 23.4 ± 7.3 hours in standard dose group, P = 0.16. The mean time for the decline in blood glucose to 250 mg/dl was 13.0 ± 5.9 hours in low dose vs 11.6 ± 6.0 hours in standard dose group, P = 0.52. A lesser proportion of participants developed hypoglycemia and hypokalemia in the low dose group, though not statistically significant. There was no incidence of treatment failure in either group. Conclusion: Low dose insulin infusion is equally effective and safe as standard dose insulin infusion in children with diabetic ketoacidosis. [ABSTRACT FROM AUTHOR]

Introduction: After the first case of Covid-19 was identified in Wuhan City, China, the numbers increased rapidly all over the world putting a huge burden on the entire healthcare system. Managing these cases posed a great challenge to the treating clinicians in the absence of targeted therapy. At this juncture, few modalities got approved as EUA (Emergency use under authorization) drugs namely Remdesivir, Convalescent Plasma (CP), and Tocilizumab (TCZ) to treat this deadly disease. Aim: To analyze the success rates of EUA therapies for Covid-19 pneumonia in our hospital. Materials and Methods: This was a prospective observational study conducted from April 2020 to October 2020 in the department of Medicine at Tata Main Hospital, Jamshedpur, Jharkhand. All adults with moderate to severe Covid-19 as per the WHO criteria were enrolled in the study with their informed consent. Patients with estimated glomerular filtration rate <30 mL/min, deranged liver function tests, electrocardiographic abnormalities, and deranged hematological parameters were excluded from the study. Thorough clinical evaluation was done in all cases. Routine investigations together with CRP, LDH, serum Ferritin, D Dimer and IL6, Chest X-Ray, and HRCT thorax were done in all cases. ECG was done in all cases and 2D-ECHO in selected ones. Depending on their clinical and radiological criteria, patients were treated with various modalities approved under EUA with close monitoring of clinical, biochemical, and radiological parameters. Presenting symptoms, clinical findings, co-morbidities, laboratory parameters, and radiological assessment were analyzed, and statistical analysis was done. The survival rate and in-hospital mortality was analyzed. Observations and Results: We had a total of 448 patients who were included in our study, out of which 326 were males and 122 were females with a male to female ratio of 2.7:1. Their age varied between 16 and 91 years with an average age of 51.4 years with a standard deviation (SD) of +/- 6.4 years. About 255 patients (57%) received only Remdesivir (176 males, 79 females), 139 (105 males, 35 females) patients (31%) received Remdesivir along with two units of CP, and 38 (32 males, 6 females) patients received a combination of Remdesivir, CP, and TCZ. All patients in our study tolerated the drugs well. About 5% of cases who received CP had minor transfusion reactions. One patient had TRALI and three patients had TACO, which was managed aggressively. Asymptomatic transaminitis was seen in 36% patients. The survival rate in patients treated with Remdesivir was 78%, those with Remdesivir and CP was 44%, and those with all three was 13%. The mean length of stay was 14.23 days with a SD of 9.06 days in patients treated with TCZ in comparison to other two modalities, which was 13.88 days with a standard variation of +/- 8.71 days in Remdesivir and 13.88 days with a SD of 8.73 days in patients treated with CP that was stastically significant. Conclusions: Though the success rate of various drugs under EUA varies in different studies from all over the world, the data to support their use are encouraging. We also observed satisfying results in our study specially with the use of Remdesivir. Therefore, EUA agents should be used early to fight against COVID-19 along with the other measures as per the protocol laid by ICMR and MoHFW. [ABSTRACT FROM AUTHOR]

Introduction: Changing demographic patterns worldwide and improvement in healthcarehas contributed to increasing visits to the emergency department byelderly patients. Geriatric patients usually have multiple co-morbidities and declining physiological functional status. This complex interplay of various factors requires a specific and curated approach from the emergency physicians.Our aim was to study the pattern and prevalence of geriatric emergencies and the profile of infectious and non-infectious causes of fever in geriatric population in our tertiary care center. Materials and Methods: This retrospective descriptive study was carried out at a tertiary care hospital of north India and included all patients aged more than 18 years who visited the emergency department over a period of six months (July 2018 to December 2018). Detailed data regarding demographic, clinical and diagnosis was obtained retrospectively from the hospital records system. The patients were divided into two groups, age less than 60 years and elderly patients more than 60 years of age for comparison. Results: A total of 24768 patients above the age of 18 years visited the emergency department over a period of six months. Out of which 5399 (27.5%) patients belonged to the geriatric age group more than 60 years of age. 2474 (45.8%) geriatric age group patientswere triaged to critical areas level one and level two as compared to 4668 (24.1%) patients aged less than 60 years. Ninety (1.8%) geriatric patients succumbed to death as compared to 77 (0.4%) patients aged less than 60 years. 651 (21.9%) geriatric patients were shifted to intensive care unit as opposed to 1038 (14.8%) patients of the younger age group.226 (4.2%) geriatric patients presented with fever in the emergency department.116 (73.4%) patients having underlying co-morbidities , had fever due to infectious causes whereas 42 (26.5%) patients had fever due to non-infectious causes. Conclusion: The clinical presentation mortality and morbidity pattern of geriatric patients differs significantly from that of younger population and requires a customized approach and dedicated emergency setups. [ABSTRACT FROM AUTHOR]

Background and Objectives: In our institution, we have an ongoing newborn thyroid screening (NBS) program since July 2001. In the initial 9 months, we used cord blood thyroid-stimulating hormone (TSH) (CBTSH) cutoff of 20 mIU/L and thereafter the cutoff was increased to 25 mIU/L. Our objective was to evaluate whether a CBTSH cutoff of 25 mIU/L is sensitive and cost-effective in NBS of congenital hypothyroidism (CH). Materials and Methods: All in-born babies are screened and those with CBTSH ≥25 mIU/L are recalled for confirmatory TSH/T4/FT4 tests. CH is confirmed with elevated TSH and low T4/FT4. Those with CBTSH 20–24.99 mIU/L were recalled for confirmatory tests in initial period of our NBS and prospectively between January and August 2017. Statistical analysis was done to derive positive predictive value and sensitivity to diagnose CH for each CBTSH between 20 and 30 mIU/L. Results: A total of 164,163 neonates were screened from July 2001 to August 2017. Of the 2352 babies with CBTSH ≥25–30 mIU/L, 1763 returned for retesting and 5 confirmed as CH (4 gland-in-situ and 1 absent uptake on nuclear scan). Of the 14,742 screened during the study period, 195 of the 293 babies with CBTSH 20–24.99 mIU/L returned for retesting and none diagnosed as CH. A CBTSH of 25 mIU/L has 99.2% sensitivity and 97.5% specificity. A lower screen TSH cutoff 20 mIU/L would result in recall of additional 300 babies/year with no definite improvement in sensitivity. Conclusions: Our data justify the continuation of using screen TSH cutoff of 25 mIU/L while using cord blood for NBS in our population. With a diverse and large population, it is important that we use feasible regional screen cutoffs for optimal use of our resources. [ABSTRACT FROM AUTHOR]

Vaccination is supposed to be the most reliable means to end the COVID 19 pandemic, but recently there have been reports of thrombosis and thrombocytopenia in patients receiving the vaccine especially ChAdOx1 nCoV-19 (AstraZeneca University of Oxford and Serum Institute of India). This has been termed as vaccine-induced immune thrombotic thrombocytopenia (VITT), thrombosis with thrombocytopenia syndrome (TTS) and vaccine-induced prothrombotic immune thrombocytopenia (VIPIT). This is a challenging situation and patients are treated with Fondaparinaux and Rivaroxaban after thrombocytopenia is corrected. Herewith, we report a case of VITT who presented to our hospital and was successfully treated over a weeks' time. [ABSTRACT FROM AUTHOR]

Background: Rorschach test has been considered a well-known and most widely used projective test for the assessment of personality and diagnostic evaluation in various psychiatric disorders. Schizophrenia is considered to be the major psychiatric illness characterized by gross distortion of reality, the disorganization and fragmentation of perception, thought, emotion, and withdrawal from social interaction. Rorschach provides both specific and general knowledge about the different areas of personality functioning, such as coping style, emotions, managing stress, mediation, ideation, self-perception, and interpersonal relationships along with correlating with the psychopathology of the schizophrenia patients. Aim: The aim of the present study is to assess the relationship between Rorschach response pattern different symptoms in schizophrenia patients. Methodology: After having informed consent, 100 patients of schizophrenia group were included as per the International Classification of Diseases 10th Revision Diagnostic Criteria for Research (ICD-10 DCR) criteria. Information about sociodemographic data and clinical details was collected using the sociodemographic and clinical data sheet from the drawn sample. For the assessment of symptoms of schizophrenia patients, Scale for the Assessment of Positive Symptom and Scale for the Assessment of Negative Symptom have been used. After that Rorschach test was administered individually to all the participants to assess the personality structure of each schizophrenia patients. Results: The results showed that there is a significant positive and negative correlation among positive, negative schizophrenia symptoms, and different Rorschach variables. Conclusion: Schizophrenia patients having positive and negative symptoms would be giving Rorschach variables indicative of moderate level of cognitive distortions, poorly controlled and disorganized affect, less conventional form of responses, poor perception and loss with reality, poor interpersonal relationships, presence of anxiety, and aggression. [ABSTRACT FROM AUTHOR]

Bi-epicondylar avulsion fracture of the distal humerus is a rare injury and poses challenges for treating orthopaedic surgeons. We present a case of 11-year-old boy who presented with bi-epicondylar avulsion fractures of the distal humerus that was managed with innovative ‘synergistic tension band analogue technique’ and resulted in good clinical outcome. [ABSTRACT FROM AUTHOR]

Background: Obsessive compulsive disorder (OCD) is a chronic distressing condition that is marked with impairment in daily functioning including social, family, and occupational areas of life. Depression is the most common comorbidity among patients with OCD. The presence of co-occurring depressive symptoms adds to the burden of the OCD. Previous studies with neuropsychological testing reveals a pattern of cognitive deficits among patients with OCD. Few studies have also shown that the cognitive deficits in OCD are mediated by comorbid depressive symptoms. Objective: The objective of this study was to assess whether the comorbid depressive symptoms have any role on the cognitive deficits in OCD. Methodology: Forty patients diagnosed with OCD with an elevated rating in Beck Depression Inventory (BDI) and 20 normal controls were chosen for the study. The forty patients were split according to the severity scores of BDI as per one group consisting of patients with only mild depression and other group consisting of patients with moderate and severe depression. Yale–Brown Obsessive Compulsive Scale has been administered to assess the severity and symptoms of the disorder. Digit Vigilance Test and Triads Test have been administered to assess attention; Comprehensive Trial Making Test (CTMT) and Rey Complex Figure Test have been administered to assess attention, executive function, and memory. Results: OCD patients have significantly performed poor than the normal controls. On further analysis, OCD patients with moderate and severe depressive features have performed poor than the patients with mild depressive features on the tests administered for attention, executive function, and memory. On assessing the role of comorbid depressive features on cognitive deficits, having mild depressive features were not found to be significantly correlated to the cognitive deficits, whereas patients having moderate and severe depressive features were found to be significantly correlated to the cognitive deficits among OCD patients. Conclusion: The findings suggest that the higher level of depressive symptoms is associated with cognitive deficits in OCD patients. It can be suggested that the comorbid moderate-to-severe depressive symptoms play an important role in the cognitive deficits found among the OCD patients. [ABSTRACT FROM AUTHOR]

Context: Certain behaviors exceed to an extent such that control becomes difficult and tolerance, dependence, and withdrawal are evident, it is regarded as behavior addiction. Internet addiction is defined as "the forced and excessive use of the Internet and the irritation that occurs when the Internet is deprived." Internet connects people to the World Wide Web and provides an easy escape for people from their immediate environment and people tend to move away from their intimate relations. Aims: We intend to find the effect of Internet addiction on marital life. Settings and Design: It was a cross-sectional study with purposive sampling from the community. Subjects and Methods: Standardized instruments were used for the assessment of Internet addiction and marital satisfaction. The correlation was estimated and the level of significance was calculated. The marriage quality scale by Shah was used as an instrument for marital satisfaction. Youngs Internet addiction test was used for checking for the presence of Internet addiction. Statistical Analysis Used: The mean, standard deviation, and correlation were estimated and the level of significance calculated. Results: Regular users of the Internet had a relative risk of 52.5% with 1.5% showing severe addiction. Trust, dominance, and dissolution potential did not show a significant correlation. Conclusions: The risk of Internet addiction was high among regular internet users. The level of psychological comorbidity was also high. It affected marital satisfaction adversely. However, trust, dominance, and dissolution potential were least affected. In the case of marital disharmony, Internet addiction needs to be looked at as an etiological factor. [ABSTRACT FROM AUTHOR]

Fever accounts for around 15% of emergency visits in elderly age group and around 5% in adults. The spectrum of etiologies ranges from non-infectious to infectious etiologies. There are very few studies done in the past highlighting the approach of patients with acute febrile illness without any localizing signs and symptoms. Objectives: The aim of the study was to formulate a targeted approach for evaluation and treatment of patients with acute undifferentiated febrile illness without evidence of localizing symptoms and signs. The secondary objective was to study the etiology and final outcome of patients with acute undifferentiated febrile illness. Materials and Methods: A protocol was devised for patients aged more than 18 years, who presented in emergency department with complaints of fever without localizing symptoms or signs of sepsis over a period of 6 months from April 2018 to September 2018. Patient's data were collected retrospectively from the hospital record section. Results: A total of 212 patients of undifferentiated acute febrile illness were enrolled in the study. Maximum number of patients [n = 69 (32.5%)], presented on second day of illness. All the patients presenting within 1 or 2 days of fever experienced defervescence. Out of these 69 patients, 35 (36.4%) were investigated of which in 29 (82.2%) investigations were not found to be useful; 75 (78.1%) patients with 1 or 2 days history of fever improved without investigations. Surprisingly, 54 patients (72%) with 1 or 2 days' history of acute febrile illness experienced defervescence without the need of antibiotics. Conclusion: There is an urgent need to devise a standardized protocol for diagnosis and treatment of patients with acute undifferentiated febrile illness in order to avoid unnecessary investigations and antimicrobial use. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to evaluate the incidence of programmed cell death-ligand 1 (PD-L1) expression in non-small cell lung cancer (NSCLC) cases and its correlation with gene mutation and clinicopathological parameters. Methods: Samples from NSCLCs patients were studied for PD-L1 expression through immunohistochemistry (IHC) using Rabbit anti-human PDL-1/CD274 Monoclonal Antibody. Genetic mutations were studied using IHC/fluorescence in situ hybridization (FISH) methods (for anaplastic lymphoma kinase [ALK]) or polymerase chain reaction/gene sequencing analysis (for epidermal growth factor receptor [EGFR]). Pearson's correlation coefficient (r) was used for correlation analysis. PD-L1 expression was analyzed for association with clinicopathological features. Results: Of the 101 NSCLC cases, PD-L1 expression was observed in 33.66% (34/101) cases; tumor proportion score of <50%: 67.65% (23/34) and =50%: 32.35% (11/34) cases. PD-L1 positivity was seen in; males: 35.5%, females: 28%, smokers: 37.7%, cases with brain metastasis: 20%, cases with pleural effusion: 20.8%, and histopathological evaluation (well-differentiated: 21.42%, moderately-differentiated: 13.79%, poorly-differentiated: 36.11%, and adenosquamous disease: 40.9%). Genetic mutation studies revealed PD-L1 positivity in 18.1% cases with EGFR mutation, 50% of ALK-IHC positive cases, and 33.3% ALK-FISH positive cases. No or very weak correlation (r < 0.3) in PD-L1 expression with gene mutations or clinicopathological parameters was observed. Conclusions: The study demonstrated PD-L1 expression in ~ 1/3rd cases of NSCLC patients. No or very weak correlation was observed for PD-L1 expression with genetic mutations and other parameters studied. The presence of gene mutations in PD-L1 expressed samples suggests further investigation on PD-L1 inhibitors in such patients for decisive treatments. [ABSTRACT FROM AUTHOR]

Radon concentration in a room can be predicted from accurate knowledge of exhalation rates from six surfaces of the room. Walls of a room occupy the maximum surface area of the room. Hence, the contribution of walls to indoor radon concentration is significant. Since the direct measurement of exhalation rate from the walls is difficult, generally, the typical building materials used for wall construction are analyzed for exhalation rates, and from these measurements, exhalation rates from walls are estimated. In the present work, an attempt has been made to estimate the exhalation rate from a wall during various stages of construction by measuring exhalation rates from various building materials and to study the effect of various layers of coatings on exhalation rates. This analysis can help in selecting right materials for construction to mitigate the indoor radon concentrations. [ABSTRACT FROM AUTHOR]

In the present study, an attempt has been made to measure the radionuclide contents in soil samples from the region around coal-based thermal power plant (TPP) in Tarn Taran district of Punjab state in India and to assess the impact of coal-based TPP on the radionuclide distribution in surrounding areas. For this purpose, soil samples collected from the region, coal samples, and fly-ash samples collected from the plant were analyzed using the gamma spectrometry technique employing thallium-activated sodium iodide detector. The activity concentration of radionuclides was observed to be higher for the samples collected from the locations nearer to the power plant and decreased as the distance from power plant increased indicating an increase in soil radioactivity due to TPP. [ABSTRACT FROM AUTHOR]

Vogt–Koyanagi–Harada syndrome (VKH syndrome) is a rare granulomatous inflammatory disease that affects the melanin pigment producing melanocytes and mainly affects the pigmented structures such as eyes, ear, skin, meninges, and hair. VKT is an autoimmune disorder, which is mainly a T CD4+ Th1 lymphocyte–mediated aggression to melanocytes, in individuals with a genetic predisposition, in particular, the presence of HLA‑DRB1 * 0405 allele. Melanin usually gives color to skin, hair, and eyes. Melanin is also found in the retina, where it plays a role in normal vision. This disease mainly leads to vision and hearing disturbances, followed by dermal problems. The most common symptoms include vitiligo, headaches, hair loss (alopecia), and hearing loss. This article describes the various signs and symptoms of VKH disease and its pathogenesis. [ABSTRACT FROM AUTHOR]

Background: In this article, we describe our experience in managing one of the worst tragedies of an outbreak of methanol poisoning in the state of Uttarakhand in February 2019. It was reported that more than 100 people of Uttarakhand and neighboring districts of Uttar Pradesh succumbed to death after consuming this toxic alcohol laced with methanol. Materials and Methods: Demographic, clinical, and biochemical data were collected retrospectively from the hospital record section of the tertiary care hospital in the state of Uttarakhand. Results: Ninety-three patients of methanol poisoning were attended by the emergency medicine department of our hospital. The mean age of the patients was 38.9 ± 10.3 years. Majority of the patients were males (92/93). The most common clinical symptoms were gastrointestinal (56; 60.2%) followed by neurological (21; 22.6%) and respiratory (18; 19.3%). Most of the patients presented within 12–24 h after consumption of methanol. The mean of latent time of presentation was 4.8 ± 2.6 h. The mean values of pH, bicarbonate levels, lactate, and base deficit were 7.13 ± 0.6, 12.3 ± 6.4, 2.6 ± 0.8, and 15.6 ± 3.8 mmol/l, respectively. Acute kidney injury (26; 27.9%), blurring of vision (9; 9.6%), and sepsis (6, 6.4%) were common complications. Seven patients (7.5%) succumbed to death. Intensive alkali therapy was the main modality of treatment. Ethanol therapy was useful in patients resistant to alkali therapy. Sixteen (17.2%) patients with acute methanol poisoning were dialyzed once. Conclusion: Patients with acute methanol poisoning have varied presentations. Gastrointestinal symptoms are the most common presentation. Such outbreaks account for the heavy toll of mortality and morbidity in the society. Prompt diagnosis and a protocol based treatment can have a significant impact on the outcome of these patients. Thus, public health warning should be immediately issued with initial presentation of the casualties. [ABSTRACT FROM AUTHOR]

There is an increasing interest in procedures to improve skin quality in acne patients with a short downtime. Off late, carbon peel laser technique which uses topical carbon suspension combined with Q-switched Nd:YAG laser treatment has gained popularity. The main advantages of this procedure are easy to perform and it requires less than 30 minutes. [ABSTRACT FROM AUTHOR]

Background and Aims: Recently, low-dose intravenous (IV) dexmedetomidine has been evaluated for obtunding the pneumoperitoneum-induced haemodynamic changes and its analgesic efficacy in laparoscopic cholecystectomy. The aim was to determine the postoperative analgesic efficacy of low-dose bolus of 0.5 μg/kg dexmedetomidine via IV and intraperitoneal (IP) route in laparoscopic cholecystectomy. Methods: Seventy-five patients, aged 18–60 years of ASA physical status I and II, undergoing laparoscopic cholecystectomy under general anaesthesia were included. Patients in Group C received IP bupivacaine. Patients in Group IV received 0.5 μg/kg dexmedetomidine infusion IV after removal of gall bladder along with IP bupivacaine and Group IP received 0.5 μg/kg dexmedetomidine in 40 mL of 0.25% bupivacaine IP. The primary outcome was 'time to first request of analgesia' and the secondary outcomes were 'total consumption of tramadol in 24 hours,' visual analogue scale (VAS) pain score. Results: In total, 75 patients with 25 in each group were included. Time to first request of analgesia was found to be significantly lower in IV (59.68 ± 71.05 min, P= 0.00) and IP group (90.80 ± 80.46 min, P = 0.001) compared tp Group C (59.68 ± 71.05 min). Mean tramadol consumption in 24 hours (152.40 ± 60.958 vs 137.64 ± 52.40 mg) and mean VAS pain score were comparable in both IV and IP groups in the initial 12 h. Conclusion: Low bolus dose of IP dexmedetomidine is as efficacious as IV dexmedetomidine (0.5 μg/kg) along with IP bupivacaine in laparoscopic cholecystectomy. [ABSTRACT FROM AUTHOR]

Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease that typically occurs following a viral infection or vaccination. The incidence of ADEM following vaccination has fallen since the introduction of non-neural rabies vaccine and very few cases have been reported due to pure chick embryo derived rabies vaccine (PCERV). Here we are reporting a rare case of probable post vaccinial ADEM. [ABSTRACT FROM AUTHOR]

Variations in origin and number of renal artery are common. We present a very rare anatomical variation where superior right renal artery was arising from celiac artery. This variation has important surgical implication. [ABSTRACT FROM AUTHOR]

Purpose of the Study: Glomerular filtration rate (GFR) is the most important parameter for the assessment of renal function. GFR by plasma sampling technique is considered accurate in the selection of donors for renal transplantation. Estimated GFR (eGFR) calculations using Gates' method and Modification of Diet in Renal Disease (MDRD) and Cockcroft-Gault (CG) equations are simple methods but have not been validated in the Indian population. Hence, we aimed to assess the correlation between these three techniques. Materials and Methods: The plasma sampling technique was done using two samples at 60 and 180 min after injection of 1 mCi (37MBq) 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA) in 66 healthy donors. Age, sex, height, weight, and plasma creatinine were recorded. Normalized GFR (nGFR) by two-sample method and eGFR (for Gates', MDRD, and CG) values were calculated using formulae. Results: There were 14 male and 52 female donors. Mean age was 46.56 ± 12.88 years (24-69 years). Mean height was 153.74 ± 8.35 cm, whereas mean weight was 56.97 ± 11.88 kg. Mean nGFR value was 80.4 for two-sample method while mean eGFR value for Gates', CG, and MDRD were 83.3, 89.36, and 97.47 ml/min/1.73 m2 (eligibility value at our institution = 70), respectively. While the correlation between nGFR and eGFR CG and MDRD was weak moderate (correlation coefficient = 0.5), nGFR and eGFR Gates' had a moderate correlation (0.686). Mean total bias for eGFR Gates', CG, and MDRD were 2.87, 8.93, and 17.0, respectively. P30 of eGFR Gates', CG and MDRD were 60.6%, 57.6%, and 62.1%, respectively. Conclusions: Due to the large variability in eGFR Gates', CG and MDRD, nGFR estimation using the plasma sampling technique with 99mTc-DTPA appears necessary while screening healthy donors for renal transplantation. [ABSTRACT FROM AUTHOR]

The pathogenic association of reactive arthritis with human immunodeficiency virus (HIV) needs more attention. In this case report we described a case of 22 year old male patient suffering from severe HIV infection. He presented with the complaints of left knee joint pain associated with swelling and tenderness. He also developed keratotic papules on palms and soles and polycyclic erosions on the glans penis. He was diagnosed as a case of reactive arthritis with HIV infection. The patient was treated with sulfasalazine and anti retroviral therapy. We, hereby discuss the underlying pathogenesis and treatment modalities in patients of reactive arthritis with underlying HIV infection. The treatment of reactive arthritis with HIV is a challenge due to limited options of immunosupressive agents. [ABSTRACT FROM AUTHOR]

Adenomatoid odontogenic tumor (AOT) is an uncommon benign odontogenic lesion, with debatable histogenesis and variable histopathology. A systematic and diverse insight into the evolution, clinical presentation, histology, and immunohistochemical findings of this lesion is reviewed and presented. We reviewed the data published from 2000 to 2014 of approximately 255 cases that revealed a significant change in the incidence of predominant site involved, in contrast to the findings published by Reichart. We have also included the chronological order of events leading to the coining of the term AOT, which shows the curiosity that has been dedicated to understanding the lesion. Immunohistochemistry is considered to be a hallmark in pathology for learning the molecular pathogenesis and giving a correct final diagnosis. Several markers have been used to investigate and understand this lesion, and a compilation of the findings has been tabulated. [ABSTRACT FROM AUTHOR]

Context: In noise induced hearing loss (NIHL), cochlear hair cells are damaged by exposure to loud sound. The basilar membrane is tonotopically organized with the lowest frequencies preferentially transduced at the apex and the highest frequencies at the base. On the basilar membrane, the outer hair cells area corresponding to the 4 kHz and the adjacent areas of 3 and 6 kHz are most susceptible to damage. Aims: To screen the factory workers for early onset of NIHL. Subjects and Methods: Study was done over a period of 2 years that is, from September 01, 2011 to August 31, 2013 on 341 steel factory workers. Workers having a minimum of 5 years of noise exposure were included whereas workers having age >45 years or with conductive hearing loss that is, air-bone gap >10 dB were excluded from the study. Results: It was found that factory workers showed normal hearing, when calculated as average of 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz but they have started developing the early changes of NIHL in the form of notching at 4000 Hz frequency described as threshold shifts. It was seen that 198 right ears out of the total 341 studied showed threshold shifts >25 dB in 4 kHz frequency, even then 70 (35.35%) right ears showed hearing in normal range. In case of left ears 198 out of the total 341 studied showed threshold shifts >25 dB in 4 kHz frequency, even then 97 (48.99%) left ears showed hearing in normal range. [ABSTRACT FROM AUTHOR]