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Development of de novo donor-specific anti-HLA antibody (dnDSA) is associated with poor graft survival in adults. However, there is a paucity of data about its prevalence and outcome in Indian children. We retrospectively assessed the proportion and spectrum of dnDSA and its outcome on antibody-mediated rejection (ABMR) and graft function. Children ≤18 years who were transplanted between November 2016 and October 2019 were included in this study. Pretransplant donor-specific antibody (DSA) was screened by complement-dependent cytotoxicity, flow cytometry crossmatch, and single antigen bead (SAB) class I and II by Luminex platform. Either antithymocyte globulin or basiliximab was used as induction. Tacrolimus, mycophenolate, and prednisolone were used for the maintenance of immunosuppression. SAB screening was done at 1, 3, 6 months, and yearly in seven children and at the time of acute graft dysfunction in eight. Mean fluorescence intensity ≥1000 was considered positive. Protocol biopsies were done at 3, 6, and 12 months and annually thereafter in seven children. Fifteen children, all males with a median age (interquartile range) of 13 years (11; 15.5) were analyzed. Only one child had pretransplant DSA who developed dnDSA posttransplant. Overall, 8 (53%) developed dnDSA over a median follow-up of 18 months. Seven (87%) had Class II, one Class I and 3 (37%) both Class I and II. Six had dQ and two had DR. All children with dnDSA had ABMR, of these two had subclinical rejection. DSAs persisted despite treatment, though graft function improved. Children with DSA and ABMR had lower graft function than those without DSA. The proportion of dnDSA was high in our study, majority against DQ. The detection of dnDSA prompted early diagnosis and treatment of ABMR.

Introduction: Surface roughness of the crowns is dependent on the pattern material used for the making as well as the procedure of investing. The study was aimed to examine the impact of various pattern materials and investment procedures on the surface roughness of nickel-chromium alloy raw castings. Materials and Methods: An in-vitro study was piloted at a tertiary care hospital. Eighty samples of inlay wax and pattern resin were divided equally. They were invested in phosphate-bonded investment material and kept under normal atmospheric pressure as well as invested under a pressure of 3 bars. The surface roughness was calculated with a Profilometer. The values obtained were compared using statistical tools keeping P < 0.05 as significant. Results: Lowest surface roughness was seen for the wax pattern invested under positive pressure. While the highest was seen for the resin patterns invested at room pressure. A significant variance between the wax 1 and wax 2 (P < 0.01); as well as between the wax 2 vs. Resin 2 specimens (P < 0.01) was noted. Conclusions: Wax patterns can be suggested as the material and method of choice because they showed the least amount of surface roughness when placed under pressure. Resin patterns when invested under pressure can also be suggested as an alternate as they also exhibited similar surface roughness as that of the wax.

Aim: The current study's objective was to find out the prevalence of malocclusion and the need for orthodontic treatment in 13- to 15-year-old school students in the Mehsana District of Gujarat using the IOTN. Materials and Methods: A descriptive cross-sectional epidemiological survey was planned among 13- to 15-year-old school-going children of Mehsana district. The sample comprised of 1290 school children. DHC-IOTN was applied to evaluate normative need for orthodontic treatment. Perceived orthodontic treatment was described by the Aesthetic component of the IOTN index. Results: Results showed that 33.7 percent of participants required little/no treatment need, 43.9 percent of participants required moderate orthodontic treatment need, and 22.4 percent of participants required severe orthodontic treatment need in the district. Conclusion: To prepare for public orthodontic and dental services, the current study provides baseline data on the need for orthodontic treatment among school-aged children.

Background: Cholecystectomy is a commonly performed laparoscopic surgery but because of variability in anatomy, surrounding inflammation and fibrosis because of recurrent attacks of cholecystitis, can be a potentially difficult surgery. Laparoscopic total cholecystectomy in difficult gall bladder cases sometimes can cause severe complications. Laparoscopic subtotal cholecystectomy can be a bridge and a safe and feasible option between open subtotal cholecystectomy and laparoscopic cholecystectomy. Aim: To study indications, morbidity and clinical outcomes in patients undergoing subtotal cholecystectomy with laparoscopy or with open surgery. Settings and Design: It was a prospective observational study. Patients presenting with signs and symptoms of cholecystitis in either OPD or IPD and in emergency were included in this study. Materials and Methods: Total 38 patients who presented to our institute with clinical and ultrasonographic evidence of acute cholecystitis were included in the study. All patients underwent detailed and thorough clinical examination, laboratory investigations, ultrasonographic, and contrast enhanced computed tomography scan in selected patients. Based on intraoperative findings, decision of subtotal cholecystectomy either by laparoscopy or via open method was made. Various outcomes like intraoperative complications, postoperative complications and need of postoperative interventions, hospital stay, and returning to daily activity were observed and charted. Statistical Analysis: The data obtained were tabulated in Microsoft Excel and analyzed using SPSS version 17.0. Continuous variables were expressed as mean ± standard deviation value. Probability value (P value) was used to determine the level of significance. P value

Background: Adolescents are likely to quickly adopt newer technologies and face detrimental effects of the same. Aim: This study assessed the prevalence and correlates of problematic smartphone and social media use among school-going adolescents. Methods: Cross-sectional study was conducted amongst class 8–10 students. Data were collected using an anonymous survey in English which included (a) sociodemographic information, (b) pattern of smartphone use and smartphone addiction scale-short version (SAS-SV), and (c) pattern of social media use and social media disorder (SMD) scale. Educative session on responsible smartphone use was followed by post-session data collection which included patient health questionnaire (PHQ-2), generalized anxiety questionnaire (GAD-2), hyperactivity subscale of strength and difficulty questionnaire (SDQ), and conscientiousness and emotional stability subscales of ten-item personality inventory questionnaire (TIPI) and post-session feedback. Results: Three hundred and twenty out of 325 responses were analyzed (180 male and 140 female). About 8% (n = 27) used smartphone for more than four hours. Prevalence of problematic smartphone use was 12.5% and problematic social media use was 11.9%. Problematic smartphone use was associated with duration of smartphone use per day and problematic social media use, which was in turn found to be associated with Facebook use and frequency of Instagram posts. About 80.6% (n = 256) participants agreed that such sessions should be conducted in schools. Conclusions: One in ten school going adolescents are likely to be having problematic smartphone and social media use. Awareness sessions in schools about responsible mobile phone use may be an acceptable strategy.

Introduction: Interstitial lung diseases (ILDs) are nonmalignant and noninfectious chronic conditions characterized by dyspnea and cough. Main Clinical Finding: A patient of 32 years had shortness of breath at rest and was aggravated by walking or exertion, coughing for the past 2 years, and decreased appetite for 10 years. Diagnosis: The patient visited physician in his hometown, who after conducting various diagnostic imaging referred him to a chest physician, where he diagnosed ILD (cystic lung disease). Interventions: The patient was hospitalized and treated with Ayurveda treatment, i.e., snehapana, virechana, and sanshamana chikitsa for 3 weeks. After that, the patient was instructed to continue oral medicaments, i.e., sanshamana chikitsa at home and is continuing the same to date and further relief was also noted. Outcome: After the hospitalization period, the patient did not require any conventional care medicine. The patient had visible relief within a few days of starting the treatment and was able to walk long distances without complaining of any shortness of breath. Conclusions: The collected data from this study suggest that Ayurveda treatment can provide noteworthy relief in ILD and further research will be helpful.

Introduction: Hip fractures in the elderly have represented a major public health concern. Studies have shown that over 90% of the patients having these fractures are people of more than 50 years. These fractures have been classified according to their anatomical location into the neck of femur fracture, intertrochanteric fracture, and subtrochanteric fracture. The neck of femur fractures is associated with high mortality in the elderly compared to young adults. Surgical treatment is an established gold standard, with the option being osteosynthesis and hip replacement. Hemiarthroplasty is one of the gold-standard treatments chosen for the geriatric age group and has yielded universally acceptable results. Materials and Methods: The study evaluates the clinical, radiological, and functional outcomes of hip hemiarthroplasty in elderly with fracture neck of the femur Data of patients above 60 years who were operated on for fracture neck of the femur by bipolar hemiarthroplasty from May 2018 till December 2021were retrieved from the Medical Records Department of SCL Municipal General Hospital, affiliated to NHL Municipal medical college. The patients fitting the inclusion criteria were selected for the study. The sample size was calculated to be 43. Data were collected from the inpatient files, and then patients were asked to complete the questionnaire form during the final follow-up. All the patients were evaluated clinically and radiologically during the follow-up, and the functional outcome was assessed using the Harris Hip Score. Thirty-five patients had a domestic fall as the mode of injury. The lateral decubitus position of all patients was used during the operation that was performed using the Southern Moore approach. Forty patients received cemented femoral stems; the remaining three received press-fit ones. Results: The average age was calculated to be 71.86 years with the male-to-female ratio of 1: 1.15 with an average follow-up of 12.7 months. Eight patients had acetabular erosion at the end of 1 year. There was no femoral stem malalignment or aseptic loosening at the final follow-up. Nine patients had excellent Harris Hip scores, and five had fair scores. The remaining 29 patients had good Harris hip scores. Bipolar hemiarthroplasty has served us well in the study. Forty-one patients were able to get back to their preinjury functional level. Only one patient reported major pain in the hip at the final follow-up. In this study, there was no incidence of dislocation or revision surgeries. Conclusion: The present study modular bipolar hemiarthroplasty provides better pain relief with early mobilization and a good level of return to daily routine activities with minimal complications.

Rosacea is a chronic, inflammatory facial dermatosis commonly found in fair skin tone population. Recent studies have shown the increasing prevalence in the dark skin tone population as well. Ocular involvement is very common and can occur without cutaneous features. Common ocular features are chronic blepharoconjunctivitis with eyelid margin inflammation and meibomian gland dysfunction. Corneal complications include corneal vascularization, ulceration, scarring, and rarely, perforation. Diagnosis is largely based on clinical signs, although it is often delayed in the absence of cutaneous changes, particularly in children. The management ranges from local therapy to systemic treatment, depending on the severity of the disease. There is a positive association between demodicosis and rosacea; however, causality is always argued. In this review, we describe the epidemiology, clinical features, and treatment of rosacea and ocular rosacea.

Aim: The present study was done to evaluate the knowledge and awareness of different provisional materials, especially polycaprolactone (PCL) and their application in prosthodontic practice. Setting and Design: A questionnaire based survey was carried out to assess the knowledge and awareness of PCL and its applications as provisional material in prosthodontic practice. Materials and Method: A questionnaire-based descriptive study consisting of 10 questions related to different provisional materials and their applications in prosthodontic practice was formulated on Google Forms. The link was created and circulated among the prosthodontist faculty members of various dental institutes and private practitioners of India with the use of digital platforms such as E-mail and social media. The data were collected and examined using Microsoft Excel software for statistical evaluation. Statistical Analysis Used: For this descriptive type of study, knowledge and awareness among prosthodontists across India was evaluated using Microsoft Excel software. Results: The use of PCL was known only to 20.75% of prosthodontists. Moreover, its application and indications are known to only

Background: Poor compliance to antibiotic therapy leads to ineffective treatment. Objective: The objective of this study is to assess compliance to oral antibiotic therapy in paediatric patients and factors affecting it. Methods: Patients aged less than 18 years, coming to outpatient department, who were prescribed oral antibiotics in last 1 week, were eligible for participation in the study. Compliance to oral antibiotic therapy and factors affecting it were evaluated through verbal interview of their caretakers. Results: Out of total of 815 participants in the study, 241 (29.6%) were non-compliant either due to not completing the course [142 (17.4%)] or due to not complying with the frequency [99 (12.2%)]. Causes of incomplete course were adverse effects [28 (19.7%)], poor palatability [30 (21.1%)] and no improvement [84 (59.2%)]. Gender, religion, age, development of child and education or occupational status of caregiver did not affect the compliance. Multivariable logistic regression showed two or more drugs in addition to antibiotic therapy (odds ratio [OR] 1.73; 95% confidence interval [CI] 1.03–2.92); more frequency intake of antibiotic in a day, that is, either twice a day (OR 2.13; 95% CI 1.24–3.66) or thrice a day (OR 3.7; 95% CI 2.18–6.48), was significantly associated with non-compliance. Though syrup formulation and low cost of prescription were associated with better compliance on univariate analysis, they did not have any impact in multivariable logistic regression. Conclusions: Restricting use of unnecessary drugs with antibiotic therapy, preferring once-a-day frequency and carefully selecting antibiotic with minimal adverse effects and better palatability improve the compliance to oral antibiotic therapy in paediatric patients.

Introduction: Telemedicine represents an innovative but untested approach to maintain patient care and reduce the risk of COVID-19 exposure to patients, health-care workers, and the public. In this study, we evaluated the applicability and efficacy of telemedicine in a kidney transplant recipient (KTR) cohort in COVID 19 era. Materials and Methods: An observational cohort study was conducted at a tertiary-care public-sector kidney disease institute in western India between March and September 2020. We evaluated the reasons, modes, and outcomes of patient contacts by telemedicine in the KTR cohort. We also evaluated the utility of telemedicine across three age groups. Results: Of 840 participants, whose mean age was 38.78 ± 12.39 years, male to female ratio was 4:1. The most common mode of communication was WhatsApp (653, 77.7%) followed by in-person surrogates (126, 15%). Acceptability of telemedicine was significantly better in younger and middle-age groups (P < 0.00001) compared to the elderly. Request for drug delivery (n = 756) was the most common reason for contact overall and managed through postal parcels. KTRs (n = 200) and donors (n = 75) were evaluated for medical illnesses. The most common medical reasons for contact were for febrile illness (n = 120) and graft dysfunction (n = 60). COVID-19-related disease was diagnosed and managed in 80 KTRs and 2 donors. COVID-19 updates were given to all contacts. Conclusion: Telemedicine is underutilized in the care of the KTR cohort. Telemedicine can be used across all ages although it's best suited for young and middle age groups. The impact of telemedicine on short- and long-term patient outcomes is unclear and warrants further study.

Background: Physical performance refers to the functional demonstration of task. Little is known about physical performance among Indian kidney-transplant recipients (KTRs). The objective of the present study was to evaluate the physical performance among Indian KTRs and to find its determinants from transplant, demographic, or behavior components. Methodology: In this single-center, prospective observational study, 149 KTRs with estimated glomerular filtration rate (eGFR) ≥45 ml/min/1.72 m2 and posttransplant duration (PTD) >6 months were enrolled. Physical performance was evaluated by 6 minute walk distance (6MWD), dominant hand grip strength (DHGS), numbers of 1 minute sit to stand (1MSTS), and time taken to perform 5 times sit to stand (5xSTS). Multivariate analysis was performed between transplant-related components (PTD, dialysis vintage, eGFR, and comorbidity); health behavioral components (total physical activity [TPA], sedentary time, fear of activity participation, body mass index, abdominal circumference); demographic components (age and gender); and each of the physical performance measures. Results: The average 6MWD was 392 ± 96.2 meters, the DHGS was 33.1 ± 6.8 kg, the number of 1MSTS repetitions was 24.0 ± 3.7/min, and the time taken to do 5xSTS was 10.6 ± 1.9 s among participants. When adjusted for cofounders with multivariable analyses, the health behavior of habitual physical activity was statistically significantly (P < 0.001) associated with all aspects of physical performance. Conclusion: Relatively low physical performance was seen among KTRs. Behavior of participation in physical activity contributed to the positive change in all aspects of physical performance against transplant and demographic variables, and it is the major determinant of physical performance.

Background: It is well established that high-quality semen can lead to an improved fertilisation rate. Ejaculatory abstinence (EA) certainly can influence sperm quality such as volume, count, motility and morphology. However, very few studies have addressed the influence of EA on intracytoplasmic sperm injection (ICSI) outcome and especially in males with severe oligo-asthenoteratozoospermia (OAT) syndrome. Aim: This study was undertaken with the purpose of evaluating the advantage of shorter abstinence period (1-h sequential ejaculation) in males with severe OAT syndrome on total usable embryo rate and thereby emphasising the potential application of consecutive ejaculate. Study Setting: This retrospective cohort study consisted of all the infertile couples undergoing ICSI cycle with the indicated seminal characteristics who had consulted the tertiary care hospital between January 2021 and July 2021. Materials & Methods: All couples in the study had idiopathic male infertility. Retrospectively, two groups were analysed, i.e., Group A with 56 subjects in which first semen sample was used for ICSI cycle and another Group B with 41 subjects in which second semen sample collected within a shorter abstinence period of 1 h was used. Statistical Analysis: The data were descriptively analysed using GraphPad Prism (vs. 9.2). Unpaired t-test and analysis of variance test were used to determine the significance. P < 0.05 was considered statistically significant. Results: The age of female subjects in Group A was 29.9 ± 3.5 years while it was 29.4 ± 3.4 years in Group B. Similarly, the age of male subjects was 32.2 ± 3.6 years and 31.9 ± 4.1 years in Group A and Group B, respectively, with no statistical differences in any gender between the groups (P > 0.05). Apart from initial progressive motility (P = 0.004), none of the parameters such as total volume, total sperm count and morphology were significantly different (P > 0.05) between Group A and samples of Group B. Similarly, parameters such as volume (P = 0.006) and post-wash motility (P < 0.001) were significantly different between Group A and samples of Group B. However, there was no significant difference in sperm count and morphology (P > 0.05). Grade 1 embryos on day 3 were 345 (62.8%) in Group A and 170 (54.3%) in Group B. Overall, the total usable embryos in Group A and Group B were 222 (40.4%) and 148 (47.3%), respectively (P > 0.05). Conclusion: With regard to compromised sperm parameters, our findings do suggest that the second ejaculate is quite relevant to 'in vitro' reproductive treatments and a simple request for a second consecutive ejaculate (shorter abstinence period of 1 h) could provide the same results in terms of fertilisation. We observed the increased chances of usable embryos in the second ejaculate group.

Aims: To study the impact of vestibular suppressant drugs (VSD) on provocative positional tests (PPT) in patients with benign paroxysmal positional vertigo (BPPV). Settings and Design: A prospective case-control observational study. Materials and Methods: Patients with a history suggestive of BPPV were tested for PPT. Patients with vertiginous symptoms and with nystagmus on PPT were classified as objective BPPV (O-BPPV, control group), while those without nystagmus with no alternate diagnosis were classified as subjective BPPV (S-BPPV, case group). Details of VSD treatment were noted in all the patients. In both groups, patients were instructed to discontinue VSD and were further assigned as the VSD and non-VSD subgroups. Patients were followed for 2 months with PPT every week. PPT positive patients were treated by vestibular rehabilitation maneuvers. Statistics: Student t-test with two-tailed, unpaired, was used for continuous scale and Chi-square test for categorical differences between the two groups. Results: 295 consecutive BPPV patients were enrolled in the study, 55 in the S-BPPV group and 240 in the O-BPPV group. Significantly higher proportion of patients in the S-BPPV group were on VSD at presentation, 80.00% vs. 53.75% (OR 2.52; 95% CI: 1.30–4.86), P = 0.006. In an unadjusted analysis of the S-BPPV group following discontinuation of VSD, PPT became positive in 79.54% of patients as compared to 18.19% in the non-VSD group (OR 35.0; 95% CI: 6.2–197.3), P < 0.001. Conclusion: A higher proportion of S-BPPV patients were receiving VSD in comparison to O-BPPV at the initial visit. The PPT converted positive four times higher after ceasing the VSD in S-BPPV patients. Study Design: Prospective case-control observational study.

Objective: To assess the therapeutic potential of ethanolic extract of Azadirachta (A.) indica in rats with polycystic ovary syndrome (PCOS). Methods: Thirty-five prepubertal female Sprague Dawley rats were randomly divided into five groups with 7 animals in each group. Group 1 received 0.5% carboxy methyl cellulose orally. Groups 2 to 5 received testosterone propionate (0.2 mg/kg, s.c.) dissolved in olive oil daily for 42 days to induce PCOS. In addition, group 3 was administered with A. indica extract (100 mg/kg, 0.5% carboxy methyl cellulose orally) from the 7th to 12th week, group 4 received quercetin (100 mg/kg, 0.5% carboxy methyl cellulose orally) and group 5 received wartmannin (100 mg/kg, 0.5% carboxy methyl cellulose orally). At the end of treatment, blood was collected for biochemical evaluation. Total follicular count and uterus corpus luteum count followed by PI3K gene expression in the ovary and uterus were evaluated. Results: The ethanolic extracts of A. indica significantly reduced body weight, ovary weight and uterus weight of rats. Extracts of A. indica also significantly increased the levels of serum glucose, total cholesterol, triglyceride, low-density lipoprotein, very low-density lipoprotein, insulin, testosterone, and luteinizing hormone. Treatment also reduced lipid peroxidation and increased antioxidant parameters in the liver homogenates of PCOS-induced rats. Histological examination of the ovary and uterus confirmed PCOS occurrence and remission state in the PCOS-induced and treated groups, respectively. Moreover, A. indica and quercetin significantly downregulated PI3K gene expression. Histopathological results of the ovary and uterus also proved the protective role of A. indica. Conclusions: A. indica leaf extract has beneficial effects in the treatment of PCOS by downregulation of PI3K gene expression.

Remarkable advances in histocompatibility testing have immensely improved the safety of transplantation and have decreased the incidence of rejections. Human leukocyte antigen (HLA) typing and crossmatches by complement-dependent cytotoxicity or flow cytometer-based methods are the vital tests involved in pretransplant histocompatibility testing. Continuous development in these testing technologies since the 1960s has refined these methodologies that can be used to predict graft rejection. Advancements from polymerase chain reaction-based methods to sequence based in HLA typing, and from cell-based cross-matches to virtual cross-matches using advanced solid-phase platforms, have enhanced our understanding about the donor-specific antibodies (DSAs) and have challenged the concept that the presence of DSA is an absolute contraindication to transplantation. Despite various developments, it is very difficult to perform a plethora of tests for pretransplant workup due to cost constraints in a developing country like India. In this review, we would discuss the advantages, limitations, and cost involved in the pretransplant immunologic workup along with an algorithmic approach for physicians that may help in decision-making amidst multiple information from different platforms.

Underlying comorbid illness is a known risk factor for severe coronavirus disease-2019 (COVID-19). Clinical course of COVID-19 in children with primary kidney disease is not well understood. We present the clinical profile and management of COVID-19 in three children at a COVID hospital in India. These children had nephrotic syndrome, hemolytic uremic syndrome, and chronic kidney disease, respectively. The first two were immunosuppressed, mandating to stop their immunosuppressive medications temporarily. Both had mild course of illness. Third child presented with respiratory distress requiring oxygen support, falling into moderate disease. Renal functions were normal in all of them. They all responded well to oral azithromycin and supportive management. None of them received chloroquine, corticosteroids, or monoclonal antibodies. All three recovered without complications.

Coronavirus disease (COVID-19) caused by novel coronavirus (SARS-CoV-2) infection is still incompletely understood in transplantation, and there have been a few reports of multisystem inflammatory syndrome in adults (MIS-A) like illness in transplant patients. Herein, we report a case of MIS-A in a renal transplant that ultimately was successfully managed. The case was a 32-year-old man, transplanted 3 years ago, with chronic graft dysfunction and no other comorbidities. He presented with a 3-day history of fever and abdominal pain with no respiratory complaints. The patient had multi-organ involvement in the form of acute pancreatitis, severe diarrhea, acute kidney injury, and shock. Inflammatory markers including D-dimer and C-reactive protein were elevated. Chest radiology showed bilateral haziness on admission. The patient had two consecutive SARS CoV 2 reverse transcription–polymerase chain reaction (RT PCR) tests negative initially but eventually SARS CoV 2 antibody test came positive. The patient was managed initially with broad-spectrum antibiotics, and after confirmation of MIS-A, steroids, intravenous immunoglobulin, and anticoagulation were administered. The patient survived and was discharged on the 29th day of admission. Our reports highlight that MIS-A should be suspected in atypical cases irrespective of COVID-19 tests and should be confirmed with repeated RT-PCR and SARS-CoV-2 antibody tests.

Objective: The logistical issues, limited resources, and surgical capacity are the challenges to simultaneous kidney exchange transplant surgeries in India. We report the first single-center 5-way nonsimultaneous kidney exchange cycle from India without donor renege. The challenges and solutions for the same are discussed. Methods: Five donor–recipient pairs (DRPs) participated in 5-way kidney exchange cycle after permission of Institutional and Gujarat State Level Authorization Committee for organ transplantation. Four DRP were ABO-incompatible and the fifth was compatible. Results: Two DRP were operated on November 22 and three on November 23, 2018. One bridge donor wait time was 1 day. All five recipients were discharged on November 30, 2018, without any medical or surgical complication; normal kidney allograft function and donor renege. We have increased chain length gradually from 2-way (June 2000), 3-way (February 2013), 4-way (April 2016), 5-way (November 2018), 6-way (February 2019), and 10-way (January 2020) in 440 kidney exchange transplants at our institute. We have used compatible pairs in gradually increasing chain length from 2-way (May 2012), 3-way (August 2013), 4-way (July 2018), 5-way (November 2018), and 6-way (February 2019) to increase transplant for difficult to match pairs. Conclusions: To the best of our knowledge, this is the first single-center 5-way kidney exchange cycle from India. Increasing chain length has the potential to offer better quality of matching and transplants rates for difficult-to-match pairs in kidney exchange.

Background: Gujarat is one of the endemic states for the prevalence of fluorosis due to high fluoride levels in water of many villages in the state. Aim and Objectives: To determine the prevalence of dental fluorosis and skeletal fluorosis in Vadodara district, Gujarat, India, and to document various interventions conducted by Government to reduce the prevalence of fluorosis in Gujarat. Materials and Methods: A cross sectional survey was carried out in 11 villages (6 with high fluoride level and 5 with normal fluoride level) by house to house visits. Various interventions like capacity building of faculties, diagnostic, treatment and counseling for fluorosis and alternate water supply facilities were provided. Results: The prevalence of dental fluorosis and skeletal fluorosis was 59.31% and 18.65% in high fluoride areas, while it was 39.21% and 12.54% in normal fluoride areas, respectively. After estimation of this problem, and other research studies carried in Gujarat, the Government of Gujarat provided a fluorine meter to measure the fluoride level in water and urine in all government medical colleges of the state. Capacity building of faculties from various departments was done regarding the epidemiology, diagnosis, treatment, and counseling of fluorosis patients. Early diagnosis and treatment were provided to all fluorosis patients visiting tertiary care hospitals. Alternate drinking water supply was also provided by the government. Conclusion: Both dental and skeletal fluorosis was high in Gujarat and field level diagnostic facilities are inadequate. A coordinated training program helped to identify the problem and suggest remedial measures. An integrated and comprehensive approach is required to reduce the problem of fluorosis in Gujarat.

Background: Kidney transplantation (KT) is widely accepted as most successful treatment option for patients with end-stage kidney disease (ESKD) for better survival and quality of life for both children as well as adults. Data scarcity on long term outcome of living donor (LD) versus deceased donor (DD) pediatric KT in developing countries prompted us to review our experience. Aims and Objectives: To determine(1) long term graft, (2)patient survival outcome and (3) rejection episodes in LD versus DD pediatric KT in developing country. Patients and Methods: This was a retrospective observational analysis of 151 LD and 37 DD pediatric renal transplants (age ≤18 years) performed at a tertiary care center between 1998 and 2011. This study was under taken to evaluate long term patient and graft survival, rejection episodes and other complications. Demographic details for all patients was retrieved. Kaplan-Meier curves were used for survival analysis. Results: Over a mean follow-up of 4.2 ± 3.61 years, one-, five- and ten- year death-censored graft survival in LDKT was 87.4%, 72.1%, 72.1% and patient survival was 92.5%, 80.9%, 75.1% respectively; 19.8% (n = 30) patients had biopsy proven acute rejection (BPAR) and 17.8% (n = 27) patients died, mainly due to infections (n = 12). In DDKT, over mean follow-up of 3.93 ± 3.5 years, one-, five- and ten-year death-censored graft survival was 90.4%, 86.4% ,73.3% and patient survival was 83.4%, 67.9%, 67.9 %, respectively; 21.6% (n = 8) patients had BPAR and 27% (n =10) patients died, mainly owing to infections (n = 6). Conclusion: LDKT or DDKT in children has acceptable graft function with patient/graft survival over long-term follow-up, encouraging to develop sustained deceased donor program in developing countries. However, infections are major cause of morbidity and mortality.

Objectives: Health status is associated with socioeconomic status (SES) of the individuals. The aim of this study was to identify any link between the SES and influenza-like illness (ILI). Materials and Methods: This observational case-control study was done on 18–70 years old patients presented with ILI (cases) at tertiary care hospital of western India. Controls were selected from demographically matched elective surgery patients except the SES. SES was evaluated as per the Modified B G Prasad 2017 scale and participants were further classified in lower SES (per capita income

Context: In addition to various barriers studied for kangaroo mother care (KMC), time opportunities for better implementation of KMC need to be studied. Aim: Time–motion analysis of the mother's daily activities was carried out to identify scope to improve KMC. Settings and Design: This is a 24-h recall-based questionnaire study. Mothers were interviewed whose newborns were admitted at a tertiary and secondary care neonatal care unit of western India over a period of 9 months from November 2015 to July 2016. Materials and Methods: Mothers were approached when the preterm neonate and mother dyad was eligible for KMC, that is, when mothers were physically healthy and newborns were physiologically stable. A total of 60 mothers were enrolled in the study. Mothers' daily activities were noted, and time spent in each activity was charted for 3 consecutive days. Missed time opportunities which could be used to increase daily KMC hours were studied. Statistical Analysis Used: To compare quantitative variables, two-sample unpaired t-test and one-way analysis of variance were used. Results: The average time of activities which consumed most was 8.24 h for sleep/rest, 3.46 h for meals/snacks, 4.89 h for breastfeeding, and a daily average of only 1.4 h was used for KMC. A quite a significant proportion, that is, 3.89 h, was spent for meeting relatives which could be used for KMC as well without affecting social meetings. Conclusion: Time–motion analysis was helpful to find out weak links in KMC implementation. Providing family-centered environment in terms of implementing KMC during meeting hours with family may augment KMC hours.

Background: Compound tincture benzoin (CTB) is used as a post-procedure skin seal antiseptic agent since ancient times; but this drug is reported to cause allergic contact dermatitis and other unwanted side effects. Our aim of the present study was to compare alternative agent like Medicated Adhesive dressing (MAD) with CTB as a post-procedure skin seal dressing. Design: This prospective randomized controlled experimental study included an equal number of patients in MAD and CTB as a post-operative seal dressing material for percutaneous interventions. Both the groups were graded for various efficacy parameters like comfort, applicability, dressing material, and immediate post-operative complications by operating doctor and attending nurse with a maximum 10 points in each group. Results: 120 patients were studied in each MAD and CTB group. Out of total patients 31.25% were males and the mean age of the patient was 33.56 ± 11.10. Allergic contact dermatitis developed in 9 (7.49%) of CTB group and in 1 (0.83%) of MAD group (P < 0.002), while local site skin infections were noted in 8 (6.67%) of CTB group and in 1 (0.83%) of MAD (P < 0.002). Operating doctor graded MAD and CTB to 7.60 ± 0.49 and 3.62 ± 0.48 (P < 0.003); and attending nurse 7.40 ± 0.49 and 3.41 ± 0.49 (P < 0.003) respectively. Conclusion: MAD is a safe, efficient and non-inferior alternative dressing material for post-procedure skin incision seal in comparison to CTB.

Objective: Congenital heart disease (CHD) is very common disease, and it is the major cause of childhood mortality and morbidity. Not much of Indian data are available particularly from the western part of the country. There are needs to further explicate the spectrum and epidemiology of the CHD. Materials and Methods: This retrospective study collected data of the paediatric patients received in our institute from January 2016 to June 2017. All simple and complex congenital anomalies diagnosed on echocardiography were included in our study. Results: Of total 22,275 cases, CHDs were diagnosed in 9728 cases with a male-to-female ratio of 1:0.6. Most CHDs (62.77%) were diagnosed between 1 month and 6 years of age. Incidence of cyanotic CHD was 27.14% and acyanotic CHDs was 72.86% with a ratio of cyanotic-to-acyanotic CHD being 1:2.7. Ventricular septal defect (26.24%) was the most common acyanotic CHD found followed by 2089 patients of atrial septal defect. Tetralogy of Fallot (13.57%) was the most common cyanotic CHD found followed by double-outlet right ventricle in 276 patients (2.84%). Conclusions: Ours is the largest Indian study till date in this spectrum which yielded new data on the epidemiology, incidence, and prevalence of CHD. Majority of the patients with CHD had acyanotic CHD with most common anomaly being ventricular septal defect. Tetralogy of Fallot was the most common cyanotic defect. This study will increase awareness in the people with a family history of CHD and health-care providers and will assist in early diagnosis.

Banff'13 update included C4d-antibody-mediated rejection (ABMR) as a separate entity responsible for graft dysfunction with limited clinical/prognostic implications. We present a retrospective study to determine the incidence and outcome of C4d-negative ABMR. A total of 987 renal allograft (RA) biopsies obtained from 987 RA recipients were studied from January 2013 to January 2016. All samples were subjected to light microscopy using standard stains and C4d immunohistochemistry on paraffin sections and reported according to modified Banff’s criteria. Adequate biopsies with immunological injuries were categorized as Group 1: pure ABMR, Group 2: combined ABMR with concurrent T-cell-mediated rejection (TCR), and Group 3: pure TCR. Groups 1 and 2 were further subgrouped as C4d positive (Group 1a and 2a) or C4d negative (Group 1b and 2b). Graft function was measured by serum creatinine (SCr) level (mg/dL). Of the 987 biopsies, 43.3% (404) biopsies revealed immunological injury. Of these, 27.7% of the biopsies revealed pure ABMR (Group 1), 60.6% revealed combined ABMR with TCR (Group 2), and 11.3% revealed pure TCR (Group 3). The overall incidence of ABMR (pure ABMR + ABMR with TCR) was 36.27%, of which C4d-negative rejections were 18.48% and 18.7% in Group 1 and Group 2, respectively. The mean SCr at the end of three years follow-up in patients with C4d-negative rejections was comparatively higher. C4d-negative ABMR, recently included in Banff’13, has a low incidence, usually presents early after transplantation but carries better outcome than C4d-positive ABMR. However, further long-term studies are still required for knowing the clinical course over years.

The kidney is the most common organ involved in systemic amyloidosis. We aimed to study etiology and clinicopathological profile of renal amyloidosis. This was a retrospective study of 40 consecutive adult patients with biopsy-proven renal amyloidosis evaluated over a period of two years. Emphasis was given to describing the clinical presentation, renal function, proteinuria, type of amyloidosis, and its etiology. Mean age of the study cohort was 44 ± 15 years (with a male-to-female ratio of 3:1). Amyloid A (AA) amyloidosis was the most common type of amyloidosis observed in 72.5% of cases. Amyloid light chain (AL) amyloidosis accounted for 17.5% of cases, and the rest remained undetermined. AA amyloidosis had widespread age distribution while AL amyloidosis was confined to those >40 years. Proteinuria was the most common renal manifestation observed in all patients. Nephrotic syndrome was seen in 70% of patients. Mean 24 h proteinuria was 6.4 g. Renal failure was the second most common manifestation seen in 70% of patients, of whom 21.4% required hemodialysis. Tuberculosis (TB) accounted for 90% cases of AA amyloidosis. The most prevalent form was pulmonary TB while the rest accounted for by rheumatoid arthritis and bronchiectasis. Among patients with TB induced amyloidosis, 61.5% had received adequate treatment for TB in the past. All patients with AL amyloidosis had nephrotic range proteinuria, five had renal failure out of which two required dialysis. Cardiac involvement was seen in two patients. AA amyloidosis was the most common type of renal amyloidosis in the present study and pulmonary TB was the most common etiology.

We present 5-year experience of renal transplantation (RT) with tissue eosinophilia (TE) in renal allograft biopsy (RAB) and its repercussions on the outcome. In total, 1217 recipients underwent RT from 2011 to 2015, and they were evaluated for the presence of ≥4% TE. Group 1 consisted of RT with RAB showing TE, Group 2 consisted of RT with RAB with rejections without TE, and Group 3 consisted of RT without rejections. Group 1 had 27 recipients, Group 2 had 395, and Group 3 had 795 recipients. The outcome in terms of graft function, patient and graft survival were evaluated and compared between three groups. All recipients received standard triple immunosuppression. One-year patient and death-censored graft survival were 80.7% and 82.7% in Group 1, 87.2% and 95.1% in Group 2, and 92.6% and 99.6%, respectively in Group 3 and corresponding mean serum creatinine (SCr, mg/dL) was 1.60 ± 0.45 in Group 1, 1.63 ± 0.58 in Group 2, and 1.19 ± 0.39 Group three, respectively. Five-year patient and death-censored graft survival were 72.9 % and 71.1% for Group 2 and 87% and 98.2% for Group 3 with SCr of 1.63 ± 0.38 and 1.25 ± 0.4, respectively. Group 1 recipients did not appear at five years. At four years posttransplant, patient and death-censored graft survival were 71.7% and 59.5% in Group 1 with SCr of 1.55 ± 0.65 mg/dL. In conclusion, the presence of eosino-phils in a renal allograft is an impending sign of graft damage and eventual graft loss.

The best and most cost-effective treatment for end-stage renal disease patients is living donor (LD) renal transplantation. It has survival benefit compared to deceased donor (DD) kidney transplant (DDKT) and long-term dialysis and provides a better quality of life. Efficient and effective kidney allocation methods are increasingly necessary to address the problem of organ scarcity. The use of kidney paired donation transplant has increased access to LD kidney transplantation (LDKT) with outstanding results. ABO-incompatible kidney transplantation (KT) and desensitization protocol can expand the donor pool, but as integral to any aggressive immunosuppression protocol, they are associated with increased risk of infection and malignancy. Given the widespread organ shortage, DDKT from donors with sepsis, donors who died from snakebite or acute kidney injury, controlled donation after cardiac death, older donors, can be considered for KT with an acceptable outcome. The acceptable outcome can be achieved with dual KT using kidneys from expanded criteria donors in older population. Dual KT from pediatric donors to adult recipients or from adult marginal DDs is a promising way to expand the donor pool. Carefully selected donor with HIV, HCV, and HBV positivity is not a contraindication for living kidney donation. Careful and meticulous selection of patient and donor is essential for successful outcome. Affordable or free transplantation is other way to increase transplantation rate in developing country. The community support can make transplantation available free to the poor patients under community-government partnership. Various steps should be taken to promote LDKT and DDKT program.

Objectives: To know the sputum smear and culture conversion among multidrug resistance tuberculosis (MDR-TB) patients. Materials and Methods: The longitudinal cohort study was conducted for 142 MDR-TB patients registered in 2010 under Revised National Tuberculosis Control Programme of Vadodara region. Three follow-ups were taken for sputum and culture examination, at completion of 6, 12, and 24 months of treatment. Individuals were interviewed to know the reasons for missed dose and default. Results: The sputum smear and culture conversion rate was 43.4%, 47.7%, and 57% at 6 months, 12 months, and 24 months of follow-up, respectively. Treatment default rate was highest (15.2%) within initial 6 months of therapy. The mean time to sputum smear and culture conversion was 120.27 days and 125.02 days, respectively. Conclusions: Most of patients who were culture positive at 6 months remained so even after 12 months. There was not much difference in the time taken for culture and sputum conversion.

Background: National Leprosy Eradication Program (NLEP) was launched in 1983 with the goal of elimination of leprosy as a public health problem. Aim: To evaluate the NLEP performance after integration into general health system from April 2003 to March 2014. Material and Methods: A retrospective record based study was conducted by obtaining data from Rajkot district leprosy center. Prevalence rate (PR), new case detection rate (NCDR), proportion of female cases, child cases, multibacillary (MB) cases, Grade II disability among new cases and release from treatment (RFT) cases were evaluated from April 2003 to March 2014 and analyzed by using Chi-square for trend analysis test. Results: The PR of leprosy per 10,000 populations was significantly declined (P < 0.001) from 0.44 in 2003-2004 to 0.15 during March 2014. Reduction in NCDR trend was statistically significant (P < 0.001). The proportion of female cases among newly detected cases showed fluctuation from 36.23% in 2003-2004 to 37.10% in 2013-2014 (P > 0.05). The proportion of child cases also showed significantly declining trend from 12.08% in 2003-2004 to 6.70% in 2013-2014 (P < 0.05). Significant number of MB cases decreased from 122 (2003-2004) to 69 (2013-2014) (P < 0.001). Grade II disability proportion was 1.45% in the year 2003-2004, increased to 5.2% in 2009-2010 and then again decreased to 3.4% in 2013-2014 (P > 0.05). Proportion of patients RFT showed fluctuation from 66.66% (2003-2004) to 45.68% (2009-2010) and then 64.66% (2013-2014) (P < 0.001). Conclusion: The NLEP is having a favorable impact on the problem of leprosy by maintaining the elimination level of leprosy in Rajkot district over a decade.

Context: Precise intraocular pressure (IOP) measurement is important in glaucoma practise. Various instruments are available today to accurately measure IOP. Thus, the question arises about which instrument to use and whether all of them can be used interchangeably. Aims: To assess the agreement between noncontact tonometer (NCT), rebound tonometer (RBT), Goldmann applanation tonometer (GAT), and dynamic contour tonometer (DCT) in measuring IOP. Subjects and Methods: 499 eyes of 250 patients were evaluated during a period of 24 months from September 2010 to August 2012 and measurement of IOP by NCT, RBT, GAT, and DCT was done in the given sequence. The agreement was assessed by use of the Bland–Altman plot keeping GAT as a gold standard technique. Results: The mean IOP value of NCT, RBT, GAT, and DCT was 15.9 ± 5.5, 15.9 ± 5.8, 15.9 ± 4.9, and 16.0 ± 4.7 mm of Hg, respectively. The limits of agreement of GAT with DCT, NCT, and RBT were found to be +5.4 to −5.2, −4.7 to +4.6, and −5.2 to +5.1 mm of Hg, respectively. Conclusions: A positive and strong correlation was found between newer tonometers and GAT, but the limit of agreement was clinically unacceptable. The use of a single tonometer should be practised at a glaucoma clinic for a patient at each follow-up.

Background: The Integrated Child Development Services (ICDS) scheme has been operational for more than three decades in India. Objective: To evaluate the various aspects of the ICDS program in terms of inputs, process and outcome (coverage), utilization, and issues related to the ICDS program. Methods: A total of 130 Anganwadi centers (AWCs) were selected including 95 AWCs from rural areas and 35 AWCs from urban areas from April 2012 to March 2015, from 12 districts of Gujarat and the union territory of Diu. Information was collected for infrastructure, baseline characteristics of AWWs, provision, coverage and utilization of various ICDS services, and various issues related to program operation. Results: A majority of pregnant (94.7%) and lactating (74.4%) mothers, and adolescent girls (86.6%) were availing ICDS services. In 96.9% of the AWCs, a growth chart was available and 92.3% AWWs were using it accurately. A total of 14.9% children were underweight including 13.5% moderately and 1.4% severely malnourished children. Two-third (66.2%) children were covered by supplementary nutrition (SN). Only 14.6% of the AWCs reported 100% preschool education (PSE) coverage among children. More than half (55.4%) of the AWCs reported an interruption in supply during the last 6 months. Various issues were reported by AWWs related to the ICDS. Conclusion: The study has reported gaps in terms of infrastructure facility, different trainings, coverage, supply, and provision of SN, status of PSE activities in AWCs, and provision of different services to the beneficiaries.

BACKGROUND: Embryonic aneuploidy may result in miscarriage, implantation failure, or birth defects. Thus, it is clinically necessary to avoid the selection of aneuploid embryos during in vitrofertilization treatment. AIM: The aim of this study was to identify the morphokinetic differences by analyzing the development of euploid and aneuploid embryos using a time-lapse technology. We also checked the accuracy of a previously described model for selection of euploid embryos based on morphokinetics in our study population. MATERIALS AND METHODS: It is a retrospective study of 29 cycles undergoing preimplantation genetic screening from October 2013 to April 2015 at our center. Of 253 embryos, 167 suitable for biopsy embryos were analyzed for their chromosomal status using array-comparative genome hybridization (CGH). The morphokinetic behavior of these embryos was further analyzed in embryoscope using time-lapse technology. RESULTS: Among the analyzed embryos, 41 had normal and 126 had abnormal chromosome content. No significant difference in morphokinetics was found between euploid and aneuploid embryos. The percentage of embryos with blastulation was similar in the euploid (65.85%, 27/41) and aneuploid (60.31%, 76/126) embryos (P = 0.76). Although hard to define, majority of the chromosomal defects might be due to meiotic errors. On applying embryo selection model from Basile et al., embryos falling within optimal ranges for time to division to 5 cells (t5), time period of the third cell cycle (CC3), and time from 2 cell division to 5 cell division (t5-t2) exhibited greater proportion of normal embryos than those falling outside the optimal ranges (28.6%, 25.9%, and 26.7% vs. 17.5%, 20.8%, and 14.3%). CONCLUSION: Keeping a track of time interval between two stages can help us recognize aneuploid embryos at an earlier stage and prevent their selection of transfer. However, it cannot be used as a substitute for array CGH to select euploid embryos for transfer.

Introduction: Chronic obstructive pulmonary disease (COPD) is a global health issue with cigarette smoking being an important risk factor. COPD affects pulmonary blood vessels, right ventricle, as well as left ventricle leading to the development of pulmonary hypertension (PH), cor-pulmonale (COR-P), right and left ventricular dysfunction. Echocardiography provides a rapid, noninvasive, portable, and accurate method to evaluate cardiac functions. Early diagnoses and intervention for cardiac comorbidities would reduce mortalities. Materials and Methods: A cross-sectional study. Total 50 patients of moderate to severe COPD according to GOLD guidelines were taken from Department of Respiratory Medicine, Smt. B. K. Shah Medical Institute and Research Centre, Vadodara. All patients underwent investigations such as chest X-ray PA view, ECG, and spirometry followed by two-dimensional echocardiography. Results: We investigated 49 males and 1 female patients ranging from 35 to 80 years of age. Twenty-nine individuals were of moderate COPD and twenty-one of severe COPD. Of these cases 29 had left ventricular diastolic dysfunction (LVDD) changes, 24 were diagnosed with PH and 16 had changes of COR-P. The study showed the linear relation between the severity of LVDD, PH, and COR-P with the severity of COPD. Conclusion: Our study put emphasis on early cardiac screening of all COPD patients which will be helpful in the assessment of the prognosis and will further assist in identifying the individuals likely to suffer increase morbidity and mortality.

Objective: Dysmenorrhea is a widespread medical problem among young females. Hypnosis has been successfully tried for alleviation of different types of pain. In this randomized control trial, we compared it with nonsteroidal anti-inflammatory drug (NSAID), which is a standard treatment, for primary dysmenorrhea. Method: Out of 116 female nursing students, 50 having dysmenorrhea were selected and divided into mild, moderate, and severe pain category based on visual analog scale (VAS) score. Each category was randomly divided into two groups. One group was offered hypnosis and the other was offered Ibuprofen for pain relief in each menstrual cycle, for three consecutive cycles. They were followed for next three cycles (i.e., 4 th , 5 th , and 6 th cycle) without any treatment. Evaluation of pain score was done at the end of each cycle in both the groups. Wilcoxon Signed Rank Test and Mann-Whitney U-test were used for statistical analysis. Results: Compared to baseline, the improvement in pain scores was statistically significant in all six cycles in hypnosis group (P < 0.0001); whereas in NSAID group, the improvement was found during first three cycles only (P < 0.0001). Comparing the VAS scores of the same menstrual cycle in both the groups, it was less in NSAID group than hypnosis group for the first three cycles. This shows the instant effect of NSAID on pain relief. However, for the remaining cycles, pain scores were less in hypnosis group compared to NSAID group. Conclusion: For dysmenorrhea, hypnosis produces lasting pain relief compared to NSAID.

The positive complement-dependent cytotoxicity crossmatch (CDCXM) is considered as a contraindication for renal transplantation (RT) since long in an effort to avoid immediate rejection. There has been tremendous development in our understanding of transplant immunology today, and more sensitive and specific methods such as flow cytometry crossmatch (FCXM) and solid-phase antibody screening are used for detailed immunological assessment. We report successful RT in a 23-year-old girl with end-stage renal disease due to vasculitis on dialysis for 2 years. Before transplantation, the patient had Anti Human Globulin CDCXM positive while Dithioerythritol (DTT)-CDCXM was negative. The patient had no donor-specific antibodies examined by Luminex single-antigen beads and her FCMXM was negative. In the posttransplant period, there was no evidence of immune injury. Her serum creatinine was 0.7 mg/dl on the 3rd posttransplant day at the time of discharge. Induction immunosuppression was rabbit thymoglobulin (1.5 mb/kg) and methylprednisolone (500 mg, 3 doses) and maintenance immunosuppression was tacrolimus + prednisolone + mycophenolic acid. We found that even though CDCXM positivity has been traditionally considered as a contraindication for renal transplantation, in few carefully selected patients, we can still proceed to renal transplantation even if CDCXM is positive if more advanced and robust immunological tools such as FCMXM and donor-specific antibodies are negative. In our patient, AHG-CDCXM was positive while DTT-CDCXM was negative making it clear that antibodies of IgM origin were probably responsible for CDCXM positivity.

Aim: To develop a simple, accurate, sensitive, rapid and precise method for the determination of galantamine hydrobromide in bulk drug and pharmaceutical dosage form. Material and Methods: The method employs wavelength detection and determination of galantamine hydrobromide at excitation wavelength 282 nm and emission wavelength 607 nm in a solution of simple distilled water. Result and Conclusion: The method was found to be linear in the range of 2-14 μg/ml having r2 = 0.9999. The mean accuracy was found to be 98.12% to 99.67%. The intraday and interday precision was found to be 0.18-0.35% and 0.13-0.46%, respectively. The limit of detection was found to be 0.29 μg/ml. The limit of quantification was found to be 0.89 μg/ml. The method was successfully applied for the determination of galantamine hydrobromide in bulk drug as well as pharmaceutical dosage form.

C1q nephropathy (C1qN) is defined by conspicuous C1q deposits in the glomerular mesangial regions of patients who do not have any evidence of systemic lupus erythematosus (SLE). We present our experience with C1qN over the last three years. In total, 1775 native renal biopsies were reviewed and dominant/co-dominant C1q mesangial deposits in patients with absence of clinical and/or serological evidence of SLE were considered as C1qN. Their clinical profile and renal function status were studied and correlated. C1qN was observed in 11 patients (0.61%), and included eight males and three females; the mean age was 36.6 years. The most common presentation was nephrotic syndrome. Hematuria was noted in eight patients (72%). The mean serum creatinine was 2.78 mg/dL. Hypertension was seen in two patients (18%). Mesangial proliferative glomerulonephritis (MePGN) was the most common histological pattern, followed by focal and segmental glomerulosclerosis and other lesions. The common codeposits along with C1q were IgM, followed by C3 and others. MePGN had better prognosis than others. To conclude, C1qN was noted in 0.61% of all renal biopsies with bimodal age distribution and may present as podocytopathy or non-podocytopathy. The prognosis depends on the morphological pattern and C1q deposits per se are not prognostic indicators.

Background: This study examines major cancer sites among the population of Gandhinagar district, India during the year 2009-2011. Objective: To study leading cancer incidents and mortality and their age distribution in both sexes in Gandhinagar district. Materials and Methods: Primary data were collected from various sources and entered in computer and analyzed. Quality checks were done, and duplicate cases were eliminated. For mortality data, death registration units were contacted. Results: Total 2360 incident cases (1374 males and 986 females) and 736 mortality cases (464 males and 272 females) were recorded during the year 2009-2011 in Gandhinagar district. Among males, the leadings sites were mouth, tongue, lung, esophagus, hypopharynx, and larynx, whereas in females they were breast, cervix, ovary, mouth, tongue and myeloid leukemia. Majority of cases were found in the age group of 35-64 years and the proportion in male and female in this age group was 62.51% and 71.05%, respectively. Conclusion: The study helps to understand the possible cancer patterns in Gandhinagar district. Foremost causes of cancer in leading sites in males were tobacco related, and the proportion of cancers associated with tobacco was 53% in our study. It highlights the possibility of easy and early detection of cancers, especially by oral cancer screening in the population. Further, the findings highlight the need of cancer cervix and breast screening among the women at regular intervals through camp approach in the community, as these are the most common sites (40% of female cancers).

Introduction: Nasal polyps are defined as prolapsed lining of the nasal sinuses. They may be present as simple inflammatory polyps or neoplastic tumors and neoplastic tumors further divided in benign or malignant types. Objectives: This study was undertaken to note the various histopathological patterns of nasal masses, their classification and relative distribution of various lesions with regard to age and sex in our setting. Materials and Methods: in this study, 70 patients are selected who presented in our hospital with nasal masses and having multiple types of clinical presentations. Time period of study is 2 years. Results: Nonneoplastic nasal masses formed the largest group of lesions; 50 cases (71.43%), followed by 20 cases (28.57%) of neoplastic nasal masses, in neoplastic masses we found 14 benign and 6 malignant cases. Conclusion: Nasal obstruction and rhinorrhea are the most common symptoms of presentation, simple inflammatory nasal polyps are the most common histological pattern seen in our environment, and surgery is the best modality of treatment.

Cytogenetics has a pivotal role in risk stratification of acute myeloid leukemia (AML). We report a case of AML with a t(4;12)(q12;p13). To the best of our knowledge, there are about 24 cases of t(4;12) reported in AML which are usually misdiagnosed as lymphoproliferative disorders on morphological assessment. This case showed specific clinical, morphological, and immunophenotypic features such as (1) pseudo lymphoid morphology, (2) dysplasia in granulocytic series, (3) an immature immunophenotype with positivity for CD34 and CD117, and (4) poor treatment response.

Fungal pathogens can be the source of serious and sometimes fatal infections following organ transplantation. To the best of our knowledge, we present the first case of cutaneous blastomycosis in a renal allograft recipient in India, a country outside the known endemic regions. This case, with the very rare and unexpected diagnosis of blastomycosis, not only reflects the tremendous diversity of infections in transplant recipients but also emphasizes the utility of serological methods even in the immunosuppressed host.

Objective: The primary objective of the following study was to determine and secondarily to compare the clinical and epidemiological characteristics of hospitalized patients with severe and non-severe pandemic influenza A (H1N1) during two waves from September 2009 to January 2011. Materials and Methods: A total of 274 cases were hospitalized during the first wave from September 2009 to March 2010 and from June 2010 to February 2011, 237 cases hospitalized in different hospitals of Rajkot during the second wave. Real-time reverse-transcriptase-polymerase-chain-reaction testing was used to confirm infection. Two wave′s comparison was made for factors associated with disease severity. Results: During the first wave 87 (31.8%) patients had severe disease with mortality of 81.6% while during the second wave there were 53 (22.36%) patients having severe disease with higher mortality (94.3%) than the first wave. There were more children up to 15 years of age that required intensive care during the second wave (30.2%) compared to the first wave (20.7%). First wave reported more females and cases from an urban area. Presence of co-existing condition, especially pregnancy was a significant risk factor during the first wave, but not during the second wave. All patients have received antiviral drug oseltamivir during both waves. During the second wave, 39.6% of patients with severe cases received it within 2 days of onset of illness. This was higher than the first wave (19.5%). Conclusion: Higher mortality was reported during the second wave of pandemic influenza A (H1N1) 2009 (H1N1pdm09). There were more cases among the younger age group than adults during the second wave.

Introduction: Early diagnosis and early adequate drug treatment is very important aspect to reduce the load in cases of leprosy. So, correct labeling of paucibacillary and multibacillary cases is a prerequisite for the adequate treatment. Confirmation of diagnosis is an important indication for histopathological examination in doubtful cases. Objectives: The present study was carried out to know the clinical profile of leprosy patients, concordance between clinical and histopathological diagnosis in cases of leprosy, and to assess the therapeutic efficacy of antileprosy therapy. Study Design: Two hundred and fifty clinically diagnosed leprosy patients attending skin outdoor patient department (OPD) were included in the study. Slit skin smear was performed in all the cases. In that case concordance between clinical and histology can be determined only in 30 cases. All the patients were treated with MDT (multidrug therapy) as per WHO guideline. Results: A total of 250 patients attended the clinic with male to female ratio of 1.7:1. The highest incidence was noted in 17-40 years of age group. In the clinical disease spectrum, 40% patients were in the borderline spectrum followed by tuberculoid leprosy (TT) (29.2%), lepromatous leprosy (LL) (26.8%), and 3.9% of indeterminate leprosy (IL). A total of 18% of patients were of primary neuritic leprosy. A total of 8.3% patients had definite history of contact in the family or neighborhood. Clinicopathological correlation was noted in 60% of patients with maximum disparity (52.9%) in the borderline group of patients. A total of 52.8% were MB (Multibacillary) and 47.2% were PB (Paucibacillary) cases. Morphological index became negative after 6 months in all patients. Mean fall of bacteriological index after 6 months was 0.19, while after 1 year, it was 1.05. Conclusion: Timely diagnosis and adequate treatment of cases with MDT is most effective. Histopathological examination is must in doubtful cases of leprosy.

We conducted a single-center prospective double-arm open-labeled study on kidney transplant patients from 2010 to 2011 to evaluate the efficacy of induction therapy using low, single-dose rabbit-antithymocyte globulin (r-ATG), 1.5 mg/kg on Day 0 (n = 80, 60 males, mean age 35.9 years), versus basiliximab (Interleukin-2 blocker) 20 mg on Days 0 and 4 (n = 20, 12 males, mean age 45.1 years) on renal allograft function in terms of serum creatinine (SCr), rejec-tion and infection episodes and patient/graft survival and cost. Demographic and post-transplant follow-up including immunosuppression was similar in both groups. In the r-ATG group, donors were unrelated (spouse, n = 25), deceased (n = 31) and parents/siblings (others), with a mean HLA match of 1.58. Donors in the basiliximab group were living unrelated (spouse, n = 15) and deceased (n = 5), with a mean HLA match of 1.56. No patient/graft was lost in the r-ATG group over a mean of one year follow-up, and the mean SCr was 1.28 mg/dL with 7.5% acute rejection (AR) episodes; infections were also not observed. In the basiliximab group, over the same period of follow-up, there was 95% death-censored graft survival, and the mean SCr was 1.23 mg/dL with 10% AR episodes. One patient died due to bacterial pneumonia and one succumbed to coronary artery disease; one graft was lost due to uncontrolled acute humoral and cellular rejection. The cost of r-ATG and basiliximab were $600 and $2500, respectively. We conclude that induction immunosuppressive therapy with a low-dose r-ATG may be a better option as compared with basiliximab in terms of graft function, survival and cost benefit in kidney transplant patients.

Aims: This study compares the clinical and laboratory diagnosis of vaginal discharge syndrome. Settings and Design: This cross-sectional study was carried out at the gynaecology outpatient department of a tertiary care hospital in Gujarat, India. Material and Methods: Total of 180 females diagnosed as vaginal discharge or cervicitis based on syndromic approach and were recruited for the study. Their clinical profile was noted and they were investigated for bacterial vaginosis, trichomoniasis, candidiasis, gonorrhoea and chlamydia infection. Results: Lower abdominal pain (35%) followed by burning micturition (23.9%) were the common associated complaints. Bacterial vaginosis was the most common clinical diagnosis, while trichomoniasis was least common. Upon laboratory investigation, 35.6% of cases of vaginal discharge and 12% of cases of cervicitis tested positive. Percentage of cases confirmed by laboratory investigation was 50, 27.8 and 41.7 for bacterial vaginosis, trichomoniasis and candidiasis respectively. Conclusion: Among all the females diagnosed as vaginal discharge syndrome, a very small percentage actually turned out to be positive upon laboratory testing.

Acute kidney injury (AKI) is one of the most challenging and serious complications of pregnancy. We present our experience on the clinical profile and outcome of 57 patients with pregnancy-related AKI, of a total of 580 patients with AKI seen during the study period. This is a prospective single-center study in a civil hospital conducted from January to December 2010. The most common age group of the study patients was 20-25 years; 43.8% of the patients had received antenatal care. AKI was observed in the puerperium (n = 34), early pregnancy (n = 10) and late pregnancy (n = 13). The cause of AKI included puerperal sepsis (63.1%), pregnancy-induced hypertension (PIH) (33.33%), post-abortion (22.80%), ante-partum hemorrhage (APH) (14%) and post-partum hemorrhage (PPH) (8%). Complete, partial and no renal recovery was observed in 52.64%, 21.05% and 26.31% of the patients, respectively. Low platelet count and plasma fibrinogen and high bilirubin, D-dimer and activated partial throm-boplastin time were observed more commonly in patients with partial recovery. Of the 57 patients, 50 received hemodialysis, three received peritoneal dialysis and seven patients were managed conserva-tively. A total of 13 patients developed cortical necrosis that was associated with sepsis in six, PPH and pre-eclampsia/eclampsia in three patients each and APH in one. Nine patients died, and the cause of death was septicemia in four, pre-eclampsia in three and APH and PPH in one patient each. In our study, puerperal sepsis was the most common etiological factor for pregnancy-related AKI. Prolonged oliguria or anuria were bad prognostic factors for renal recovery. Sepsis, thrombocytopenia, disseminated intra-vascular coagulation and liver involvement were associated with increased mortality.